2nd level appeal/review???
Ok, I know you all are probably tired of hearing about my insurance troubles. Sorry. I got a call today from the nurse that has been assigned to me. She wanted to explain my 2nd level appeal/review. She tried to stress that this is informal, but even though it may be informal, it is very important to me and my life. It will be a conference call. They will have a doctor, 2 nurses and the nurse that called today will be the moderator(informal??). She said I could explain why I felt I should be approved or shouldn't have been denied, 10 - 15 minutes, and if they wanted, they could ask me questions. Then the info would be sent to another doctor either inernally or externally.
Has anyone else had to do this? How did it go , what should I really expect? Any insight???
Peace,
Linda
BTW it is not for 3 weeks
Has anyone else had to do this? How did it go , what should I really expect? Any insight???
Peace,
Linda
BTW it is not for 3 weeks
Hi Paul,
My request was first denied because the information received does not indicate participation in a physician supervised nutrition and exercise program of 6 months duration in the last 2 years (including dietician consult, low calorie diet, increased physical activity and behavioral modification).
The paperwork that was sent in included 9 months of office visits where they all mentioned decreased calorie diet and increased activity, except for the month I had cervical spinal fusion, it said decreased calorie diet, but decreased activity ( i was on bedrest after surgery and increase activity slowly). I t also included 5 years notes of weights, my psych consult and letter of medical necessity from my PCP. We didn't know about the nutrition consult, so I got that done and sent in, but it didn't make it in time for the first appeal. The peer to peer was a no go because I was told the PCP had 14 business days from the denial to initiate it, well when they called in to do that, they were told the time had run out, it was 14 calendar days, it didn't matter if there was a holiday or not. I even had the name, date and time of the call when I was given the 14 business day information and was told it didn't matter, because it had already been kicked out. I also have been attending the bariatric support group meetings, so I got certificates for that to send in, I had not included those the first time, the only problem there is in the past year( I started this in June of last year) there have been 3 different co-ordinators and the present co-ordinator would only give me certificates of attendance for while sne was there.
Does this help any?
Oh, my BMI is 47, I'm 52, have hypertension, depression, pain in my feet( surgery once with no relief), spinal stenosis and spondylosis, GERD and stress urinary incontinence.
Thanks for any insight.
Peace,
Linda
Most Active
Recent Topics
My insurance will not pay for my excess skin that hang down to my knees
Hockeymom87 · 0 replies · 605 views
Hockeymom87 · 0 replies · 605 views
