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Re: Re: Appeal letter

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Hi Tess,

See how close the ICD-9 codes are. Either it was picked up incorrectly or

they missed that number and put the decimal point in the wrong place. I

thought something smelled real WRONG. This should be easily and quickly

corrected. I can't think of one policy that doesn't cover a T & A for

chronic tonsillitis.

Good luck and let us know what happens. BTW, I don't think I would hold my

breath waiting for any kind of a big apology from the HMO....don't think they

have that letter loaded into their computer! I know from first hand

experience!!

Gentle, tender, angel hugs,

Debs in FL

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Hi Debs...you are such an angel. Your support & encouragement mean a

lot to me. The ENT's office opens soon, and I'll be calling them.

Are you feeling any better?

Hugs & Love & Prayers...

Tess

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Thanks, , for the information. I'm calling my ENT is just a few

minutes. You are SO knowledgable, and so sweet to boot!

Many hugs....

Tess

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on my appeal i got a letter from my company today saying again i sent no

objective information. they sent me a copy of the ime report and although he

does state that the day of the evaluation i could do my sedentary job. but

also noted inflamatory arthropathy have a day to day variance. in general,

they are progressive, and she may have chronic pain and eventual impairments

in her abilities for self care and mobility. in his opinion no further

testing needed. long term therapy including predominant physical therapy/

aqua based, but she states in the past it was not tolerated. long term

chronic pain treatment would be indicated as well as possible use of

tricyclic antidepressant medications in low dosages at nighttime for sleep

restoration and pain management. he would also recommend a physiatrist with

ongoing pain management expertise. they have sent this to my rheumi and my

foot dr for their comments. then they will review. kathy in il

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