Appealing to Insurance

Has anyone ever appealed to Badgercare? I have my hearing date in 2 weeks. I'm just wondering what I should expect and any advice. I' appealing on the grounds that they changed the criteria the same month that I submitted for my PA request. Everything that I have found about the change only states the month and year (December 2005) Not an exact date. What do you think my chances are of having the denial overturned?? Thanks, Kimmie

Hi Kimmie, I'm sorry you have to go through this, and I wish I could offer advice. As I too am just waiting for approval from Badgercare, all I can say is I wish you all the luck in the world!! Dana

Thanks for your support! Kimmie

hello i am in the process of appealing a decision they made to deny my breast reduction surgery. i have 6 letters from various doctors, various specialties im hoping that will persude them. please let me know what you find out. my thoughts are with you beth

Beth, Thanks for your support. I wish you luck with you appeal. Kimmie

Kimmie, Has Lauren been able to provide you with advice? What you shud expcect and so forth??? Gala

Gala, Not really. They are telling me the change went into effect on 1-1-06 and I just received a letter in the mail yesterday from MA Appeal Department stating that it went into effect on 12-13-05. My PA request was submitted on the 21st of Dec. I spoke with the appeal judge yesterday to find out what info they needed from me. He's pretty much saying that the hospital new about the change and submitted the PA request anyway, without notifing me of the criteria change. Apparently it is the hospitals responsibilty to do this. Oh well, My appeal hearing is on the 23rd of this month. Hopefully something can be worked out! Kimmie

Hi Kimmie, I wish I could help you, but I'm kind of in the same boat. Your situation sounds horrible. I can't imagine getting that far and then running into this issue due to just a few days!!! Please let me know how things go. I started my program and recently found out that since I have no co-morbidities, I won't get approval. Lucky, for me I wasn't as far into it as you, but I was just crushed to find that out. I'm wondering if there's a way to appeal and fight the system. I don't think it's fair for people who have come so far and then suddenly get told it's all over. I'm currently trying to research as to what my options are, though it feels like they're few and far between. Best of luck to you in your appeal process, I hope everything goes well for you! I'm anxious to hear what they say.

Thanks for your support. You've got mail! Kimmie