Re: Desense Denied by Insurance

[Guest guest]

Sam,

I know Kaiser is in California - is that the HMO you are in? That is what I

have in Colorado and they covered my desense at National Jewish, which had a big

price tag. I was referred there by my Kaiser immunologist/allergist Dr.

Cvietusa. Perhaps if you are also on Kaiser your immunologist could get in

touch with Dr. Cvietusa to find out how he made the case for the referral to be

covered. I had no trouble and my copay was only $100 for the 2 day desense.

Thank goodness for insurance when it works! I hope it will work for you!

Jennie

>

> Hello,

>

> I live in Southern California and I am going to have endoscopic sinus surgery

this Wednesday. My ENT tried to get the desense approved by my insurance but it

was declined. Unfortunately I have HMO for the time being.

>

> The cost is about $5k for the two-day procedure so it's a cost I would like to

avoid. I went to my primary physician to ask for his help to get it approved and

he said he would try. Wish me luck.

>

> Does anyone have any advice for improving my chances? I told the doctor I

would send him some of the papers from White and son in San

Diego (Scripps). I thought he might be able to use them if they decline on the

first round.

>

> Any similar experiences out there?

>

[Guest guest]

I have Pacificare. On Mon, Jan 31, 2011 at 7:20 PM, gypsymouse@... <jratico@...> wrote:

 

Sam,

I know Kaiser is in California - is that the HMO you are in? That is what I have in Colorado and they covered my desense at National Jewish, which had a big price tag. I was referred there by my Kaiser immunologist/allergist Dr. Cvietusa. Perhaps if you are also on Kaiser your immunologist could get in touch with Dr. Cvietusa to find out how he made the case for the referral to be covered. I had no trouble and my copay was only $100 for the 2 day desense. Thank goodness for insurance when it works! I hope it will work for you!

Jennie

>

> Hello,

>

> I live in Southern California and I am going to have endoscopic sinus surgery this Wednesday. My ENT tried to get the desense approved by my insurance but it was declined. Unfortunately I have HMO for the time being.

>

> The cost is about $5k for the two-day procedure so it's a cost I would like to avoid. I went to my primary physician to ask for his help to get it approved and he said he would try. Wish me luck.

>

> Does anyone have any advice for improving my chances? I told the doctor I would send him some of the papers from White and son in San Diego (Scripps). I thought he might be able to use them if they decline on the first round.

>

> Any similar experiences out there?

>

[Guest guest]

I had my doctor include information on how it might save the insurance company money in the long run because I woudl likely need less surgery and less medication. I also asked to see information on the background of the people who were rviewing my case and specifically if any of them had any experience with samters. be persistent, I made a lot of phone calls until I found someone who was willing to help. I also called the regulatory agency for insurance in my state for any help they could offer.

From: samters [mailto:samters ] On Behalf Of sam_miller_2002Sent: Monday, January 31, 2011 8:12 PMsamters Subject: Desense Denied by Insurance

Hello, I live in Southern California and I am going to have endoscopic sinus surgery this Wednesday. My ENT tried to get the desense approved by my insurance but it was declined. Unfortunately I have HMO for the time being.The cost is about $5k for the two-day procedure so it's a cost I would like to avoid. I went to my primary physician to ask for his help to get it approved and he said he would try. Wish me luck. Does anyone have any advice for improving my chances? I told the doctor I would send him some of the papers from White and son in San Diego (Scripps). I thought he might be able to use them if they decline on the first round. Any similar experiences out there?