Circles lead to direction
Happy Monday everyone. How do ya like my intro, huh? did it make you stope and think for even a brief second? Oh well. I chose the intro because all of last week I felt I was going in circles and was not able to focus really on the appeal. Something was just plain missing. So I took the week end and got organized and spent the day creating a letter of appeal, copying all the paper work I need and addressing envelops to the California Department of Insurance and United Health Care Appeals Unit.
I am sending them Fed Ex in the morning and they should have them by Thursday I think. I was going to fax the paperwork but want a way of tracking them. If my calculations are correct and United Health Care responds with in the 15 business days as they say they will then I should hear something on,by. or around August 27.
In the packet I included a copy of case laws that I have on how the laws of the state where the insured resideds can not be ignored. California Code of regulations. Maryland State law, my entire pakckage that was submitted from my surgeons office, my letter of appeal and three letters of medical necessity. And a copy of the letter of denial.
Basically I have found out that there is a two tier appeals process then an independent medical review is available and the Insurance Company is bound by that decission.
I know I won't make the set date of September 8, 2009 for the surgery however I do hope to make a date sometime in November. I also hope that I do not have to do all of the testing over again. That would suck.
I can only keep a positive attitude and hope for the best.
Ciao
Zells_lori
Wow!! Lori, sounds like you have all of your ducks in a row!! Don't worry now about what MIGHT have to be repeated as far as testing - I'm sure some will, because some test results have limited shelf life, but don't cross that bridge yet.
I'm glad you've made copies - the last thing you want to hear is, "Oh, we never got that!"
Good luck and keep on plugging away!
Hugs,
Tia
