Should have stayed in bed today!!!

Today was not a good day. First off, my husbands workmans comp lawsuit went to trial today.......the other side is not wanting to pay $90,000.00 for his medical costs. So we have to take it further.....another trial Oct 11....soooooo longgggg from now, the judge is also wanting depositions from all the doctors, the medical reports weren't enough I guess. So disappointing, we are scraping bottom as it is and now have to wait over 2 months to get any financial help. My husband was injured at work and has had 3 surgeries in 1 year, a spinal fusion and is considered disabled. He has worked for the company for 38 yrs. Now that is enough for anyone to have a bad day but add to that... I WAS DENIED!! I am so bummed. The reason was not following a medically supervised diet for 12 months. I don't have any of the records from about 10 yrs ago, I was on an 1800 calorie Diabetic Diet before I was on insulin. I was hoping with my BMI being so high 48.2 and with all my comorbidities, that might have made a difference. You would think that they would want to pay for the surgery as opposed to paying for meds, medical equipment, possibly dialysis down the road. My PCP is doing the physicians appeal and I will start my appeal. I am so bad with words though. I am such an emotional person. I have no clue what I am supposed to do so I will be on the phone first thing tomorrow to find out exactly what I need. I want to know what documentation I have to show, when I do this medicall supervised diet, so I can be approved. So looks like I am gonna be on hold for surgery for 1 yrs. I am so devastated, just want to hide in the corner and cry. Anyone have any ideas oradvice on what to write in my appeal.....

Was a drag all that is. Keep your focus. Can your surgeon's office help you? I know there are people on the board who have written appeals and won. They will answer you better that I could. I was in on the first try thanks to Chuckie and Rheah. Positive vibes for you. kp

((((((((((((Deborah)))))))))))) I am so sorry you are going through so much. I wish there were something I could say to make it better. I hope things turn around and start to look up soon. They say that things happen for a reason, sometimes we don't know what the reason is, but remember hind sight is 20/20 and maybe someday you will look back on this and realize that there was a good reason for all of this. Much luck to you and your husband. Shawn M

I'm sorry for all your struggles. Sometimes life is just downright tough..but it will get better. Hang in there. I had to do an in person appeal for my insurace (HAP HMO) and it was worth every minute I put into preparing for it, as it made me even more knowledgeable and they did approve me. Don't give up, some insurance companies just want to see you fight for it and make sure YOU want this and that you've thought the whole process through. If you want to cry and hide...do it for a day, then pick yourself up and get busy with that darn appeal! I sent the insurance company a very well organized binder with tabs for each section they would require, I had letters from my husband and parents included in part of it (under the emotional tab), I put pictures in the front (as difficult as it was to take them knowing they would be seen). I did everything I could for that appeal and it worked. So don't give up!!!!! Blessings, Kim

Hi deborah I am sorry you and your husband are going through such rough times, i know exactly how you feel, i've been off work two months and am feeling it too.. I hope it can get better for you. As for the insurance, I had nothing documented either. I appealed to the end and finally got approved with an in person appeal. Don't give up , that's what they want you to do. Get your appeal in asap! You will win, i am sure of it. Stay focused and don't give up this fight. Keep researching and reading profiles. Hugs Linda

(((((Deb)))))) I'm so sorry to hear of your bad day. Follow Kim's plan....you just never know. Julie in Ludington

Thank you all for your support. I was being a little emotional. I should know better than to get so emotional over something I don't have much control over. My PCP's office has already done a rough draft of their appeal. I should be getting my denial letter and will give me instructions on how to handle my end. The woman at HAP I talked to said if my reason for surgery is life threatening they can expedite it within 72 hours, an appeal that is. I said Sleep Apnea is life threatening and she just kept repeating what she said. She didn't tell me it wasn't. Maybe that was her way to tell me to go with that. My daughter is a very good writer, a 4.0 student, so she is going to help me write my appeal letter. I said in my profile I knew with was going to be a challenge....I am picking myself up and carrying on. I will not give up, I know in my heart this is what I need.