Help need advice Insurance Denied & PCP not helping

Mary M.
on 9/9/05 10:58 pm - WAPPINGER, NY
Help, Much needed advice. I feel very alone right now and am looking for any advice regarding my situation. I am at the point now that I have completed and passed every test needed. I completed 6 month of physcian diet plan with my PCP & reached my 5% goal and she from the beginning claims she supports me in this surgery and yet wrote me a barely sufficient support letter without any diet history. I have put up with not so nice remarks by my PCP's nurse who had the nerve to say to me "What makes me think Insurance would pay for this" I was ultimately denied by Aetna and was told the only reason was my lack of diet history. My PCP was given the chance to have a peer to peer review and said she would. 1 1/2 weeks later I checked with Aetna and she didnt do the review and I told her all the office notes from my diet visits did not get into my folder to. Now she has not returned my calls in 2 days. Surgical Associates told me I could do diet visit with their nutritionalist. I feel iI shouldnt have to since I did all of this already. They have not been able to help me much. My BMI is now 40 so I really can't lose any more. Do I start over? What recoarse do I have with my PCP if any? Do I get a new PCP and how long are my test results good for? I feel so helpless my surgery was supposed to be on Sept 15th I was so excited and now I feel like giving up hope. For anyone who has the patience to read all of this thank you Mary Mc
bonnieb
on 9/9/05 11:27 pm - Binghamton, NY
Get all your info from her..all your tests results and med records and submit them to your ins. co. yourself. Also get ahold of your ins. company's appeal dept and submit to them in writing why you want to appeal the decision. I had to fax them alot of the info myself, and appealed their decision twice. I finally got them to work with me because i had everything i needed to have the surgery done too. Do not give up! Maybe you should look into a different pcp. Your tests are good for a while, but don't wait too long. I did need a new psych evail done, it was only good for 3 months. Good Luck, I know it's very discouraging but don't give up. I'll be praying for you and rooting for you.
bonnieb
on 9/9/05 11:28 pm - Binghamton, NY
by the way...where is Wappinger, NY?
stephenw
on 9/11/05 9:34 am - Cherry Hill, NJ
Your medical records are yours. Get a copy and send them yourself.
Most Active
Recent Topics
×