Question:
Is it better to Teleconference or show up at appeal?
I have BC/BS Health Options of FL. I was denied the first time for lack of 1yr supervised diet info. I was able to find 8mo worth, so I faxed that in along with 12 appeal letters from myself and family. BC/BS called today and said my hearing is set for this coming week. They gave me the option of Teleconferencing in or being there. I chose to listen in. Should I go? Does anyone know what they will ask or what I can expect? Thanks in advance! :) — Deena C. (posted on January 23, 2003)
January 23, 2003
Although I have a different insurance (Group Health Options) our situations
are similar. I was denied twice for the same reason and on the third denial
I was offered an appeal committee. I chose to go the the meeting. I brought
3 support persons who had already had the surgery with the same insurance
company. I also brought 18 letters from other people who had had the
surgery. We had about 20 minutes to present "my case" to
insurance staff, doctors, patient advocates, and appeal personnel. It went
well. I spoke and then my friends did also. It is amazing how touching
these stories can be. I think it helped my case a great deal! Not everyone
on the committee was even familiar with the surgery, so all the information
really helped. I received my approval letter within two weeks. They did
make me finish out a few more months of a diet, but I was able to do this
while on the waiting list for surgery, so there was no penalty or extra
waiting period. I hope this helps. Please feel free to email me with more
questions.
WendyS
— Wendyrvp
January 23, 2003
Go in person and bring live witnesses for your case. I work in the
courtroom and it is always more effective in person than by remote.
— Darlene P.
January 23, 2003
GO! IN PERSON! Its always easier to ignore a voice on a phone, a lot harder
when its a living breathing person. Take the day off and present a good
case. Ideally take a post op along who has done well and lost 100 pounds or
more. Have them tell their story with there before photo. GOOD LUCK let is
know how it comes out...
— bob-haller
May 5, 2003
I too have BC/BS of Florida Health Options (HMO) and I was denied for
abdominoplasty surgery. I am working on my appeal now. All I can say is
be persistant!! From what I've been reading, not too many people get
approved on the first submittal. If you want it, it's worth fighting for.
— Jeanette D.
July 30, 2003
I have Cigna HMO St Louis. I was denied for Adominalplasty all 3 times.
My advice is definately to go in person to the review. I did mine on the
phone and there were only 3 other people on the line and none of them had
any medical degrees. If I had known before hand, I would have been there.
— Donna W.
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