Anyone Participated in an Insurance Appeal Review Board?
Hi,
I was wondering if anyone has been denied for the DS and then had to do an appeal. I had my appeal escalated to the 2nd appeal for health reasons so that I can get a revision. The insurance appeal board invited myself and/or my surgeon (DR K) to participate in the panel review which will be held tomorrow and they can ask us questions and vice versa. They will make a decision of whether or not to overturn their denial by Thursday. I was told it is only like a 10 minute phone call; was wondering if anyone else has done this and if so how did it go?
Thanks!
I was wondering if anyone has been denied for the DS and then had to do an appeal. I had my appeal escalated to the 2nd appeal for health reasons so that I can get a revision. The insurance appeal board invited myself and/or my surgeon (DR K) to participate in the panel review which will be held tomorrow and they can ask us questions and vice versa. They will make a decision of whether or not to overturn their denial by Thursday. I was told it is only like a 10 minute phone call; was wondering if anyone else has done this and if so how did it go?
Thanks!
RNY 9/24/08
Surgery Weight - 344.4
Revision to DS 9/22/10
Surgery Weight - 231.0
Plastics 4/14/11
Surgery Weight - 211.0
Current Weight - 179.8
Goal Weight - 160.0
I am staring at Ambition, shaking hands with Success, and smiling at Determination - What are YOU doing? *smirk*
"They ON IT cause they WANT IT!"
Surgery Weight - 344.4
Revision to DS 9/22/10
Surgery Weight - 231.0
Plastics 4/14/11
Surgery Weight - 211.0
Current Weight - 179.8
Goal Weight - 160.0
I am staring at Ambition, shaking hands with Success, and smiling at Determination - What are YOU doing? *smirk*
"They ON IT cause they WANT IT!"
On August 11, 2010 at 5:35 PM Pacific Time, millikan01 wrote:
Hi,I was wondering if anyone has been denied for the DS and then had to do an appeal. I had my appeal escalated to the 2nd appeal for health reasons so that I can get a revision. The insurance appeal board invited myself and/or my surgeon (DR K) to participate in the panel review which will be held tomorrow and they can ask us questions and vice versa. They will make a decision of whether or not to overturn their denial by Thursday. I was told it is only like a 10 minute phone call; was wondering if anyone else has done this and if so how did it go?
Thanks!
Good luck!!! It will happen for you!!!
Joyce Rny 2/11/03-> ERny 12/26/07-> Duodenal Switch 5/12/2010
www.dsfacts.com , www.dssurgery.com , & www.duodenalswitch.com
Hey!
Dr. K participated in the Appeal Review Board today, as did I. We both rocked and called them out on a lot of things. The meeting was at 2pm, and unfortunately, they upheld their denial at 4pm. I have now escalated it to an emergency 3rd Level Appeal which is an Internal Medical Review. This is done by another doctor. I am not sure if my insurance (Regence Blue Shield) does peer to peer reviews, but I know this is the last and final appeal that I have. I am hoping they will just approve it - especially since my insurance would cover it at 100% since ive met my deductible for the year already! They will have an answer by Tuesday and I will let you know how it goes.
Dr. K participated in the Appeal Review Board today, as did I. We both rocked and called them out on a lot of things. The meeting was at 2pm, and unfortunately, they upheld their denial at 4pm. I have now escalated it to an emergency 3rd Level Appeal which is an Internal Medical Review. This is done by another doctor. I am not sure if my insurance (Regence Blue Shield) does peer to peer reviews, but I know this is the last and final appeal that I have. I am hoping they will just approve it - especially since my insurance would cover it at 100% since ive met my deductible for the year already! They will have an answer by Tuesday and I will let you know how it goes.
RNY 9/24/08
Surgery Weight - 344.4
Revision to DS 9/22/10
Surgery Weight - 231.0
Plastics 4/14/11
Surgery Weight - 211.0
Current Weight - 179.8
Goal Weight - 160.0
I am staring at Ambition, shaking hands with Success, and smiling at Determination - What are YOU doing? *smirk*
"They ON IT cause they WANT IT!"
Surgery Weight - 344.4
Revision to DS 9/22/10
Surgery Weight - 231.0
Plastics 4/14/11
Surgery Weight - 211.0
Current Weight - 179.8
Goal Weight - 160.0
I am staring at Ambition, shaking hands with Success, and smiling at Determination - What are YOU doing? *smirk*
"They ON IT cause they WANT IT!"
I just sent you a pm. I haven't been through where you are yet but wanted to share what has happened with me and what Dr K said.
WHEN LIFE KNOCKS YOU DOWN TO YOUR knees, JUST REMEMBER THAT YOU ARE IN THE PERFECT POSITION TO PRAY. HW 395, RNY 4/2/07 345, Lowest Weight 248, Revision to Distal RNY 1/13/09 278,Revision to DS 10/15/10Most Active
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