Friday, June 19, 2009

Still Battling

Here's the update, no frills, no funnies, just facts.

Before leaving on our big trip and just a day or so before my lovely stay in the hospital, I spoke to my PCP, who had submitted the referral to see the SD doctor. He had spoken to my IPA about why they had denied the claim and when he asked if they read the letter he attached with it, explaining my case, they said they hadn't, all they did was look at the doctors name, knew he wasn't in network and they automatically denied the referral. My PCP was baffled and appalled by this but said he would present it to his boss, who happens to be the head of the doctors side of the IPA. He said not to get discouraged, we would continue fighting.

When we left for the cruise, we knew that my patient appeal was in to my HMO and that my doctors appeal was in the works on the doctors side of the IPA. All we could do was wait.

Well after a few back and forths over the phone and email, earlier this week we learned that my PCP had spoken to his boss, they had presented my case and it was now being reviewed by the head of the HMO. He still said it looked promising, but was so sorry that it took so long and that everything was moving at a snails pace. He said this was just a stupid game of chicken the insurance company plays to see if the patient or the dr will blink before they do. He seemed pretty upset. But none the less we are still hopeful.

Then yesterday I received a hefty envelope from the HMO, as I've described before that's never a good sign. And it wasn't, this letter was in regards to my patient appeal to the denial and they have decided to uphold their original decision. Based on the letter, it seems this was only decided on paper work, the terms of my health plan and not my personal medical history or trauma. GRRRRRRRRRRR.

So at this point all hope for insurance approval for me to see the SD doctor hinges on the doctors appeal. Hopefully we'll hear something soon. If not then I guess we'll be paying to have a consultation and then see what happens from there.

That's the update, it sucks, I'm tired and I'm ticked off. But I'll move forward and keep fighting like I always do, don't have any other options.

1 comment:

Mrs.Newton said...

You are such a trooper and could teach even the most seasoned military how to be a better fighter! Our prayers and positive thoughts are with Dr. A's appeal. If that doesn't work, we will make this happen. We're not taking no for an answer and we are behind you 100%!!