Re: Update - Ins. Doctors don't speak English?

[Guest guest]

Thanks , Marci got in touch with me and is helping.

Hi Gail,

Our insurance is through my employer. The HR Director and I called

Hobbs Group yesterday (they are our insurance broker)and they said

they would call me back with a rep from Horizon. They did call back

and the girl from Horizon said they cannot find my appeal. She also

confirmed that if I were to speak to the Doctors and nurses from

their medical review board that I would not understand them because

their English is very bad. I questioned her about nurses because I

was told doctors would review my appeal and she said that either

nurses or doctors could review my appeal. I told her I did not feel

it was fair that a nurse and not a doctor would make a decision on my

appeal, if they ever find it! She wants me to send another package

in but I told her I wanted to speak to the complaint investigator

first and to my attorney.

About an hour later two higher ups called me on a conference call.

They started out by saying, Sorry we goofed please send us another

package and we will get it reviewed and approved right away.

Approved? How can they approve it if they do not know what it says.

If they put it in writing that they will approve it like he told me

over the phone I'll send him the package right away. But I doubt

it. I told them the same thing about speaking to the complaint

investigator first and to my attorney. I also asked them about the

doctors/nurses not speaking good English and one guy said, " that's

irrelevant " . I told him it wasn't irrelevant to me. He said the

doctors and nurses read and understand English perfectly.

I've got a call into both the complaint investigator and my attorney.

Barbara (Sofia DOC Grad 9-17-02 & Catalina)

[Guest guest]

Great job Barbara! Sounds like you have them running. They know

you have them b/t a rock and a hard place. Most people don't know

they are out of compliance by losing all of that.

Dane's mom DOC Grad

--- In Plagiocephaly@y..., " catasofia2002 " <catasofia2002@y...>

wrote:

> Thanks , Marci got in touch with me and is helping.

>

> Hi Gail,

>

> Our insurance is through my employer. The HR Director and I

called

> Hobbs Group yesterday (they are our insurance broker)and they said

> they would call me back with a rep from Horizon. They did call

back

> and the girl from Horizon said they cannot find my appeal. She

also

> confirmed that if I were to speak to the Doctors and nurses from

> their medical review board that I would not understand them

because

> their English is very bad. I questioned her about nurses because

I

> was told doctors would review my appeal and she said that either

> nurses or doctors could review my appeal. I told her I did not

feel

> it was fair that a nurse and not a doctor would make a decision on

my

> appeal, if they ever find it! She wants me to send another

package

> in but I told her I wanted to speak to the complaint investigator

> first and to my attorney.

>

> About an hour later two higher ups called me on a conference

call.

> They started out by saying, Sorry we goofed please send us another

> package and we will get it reviewed and approved right away.

> Approved? How can they approve it if they do not know what it

says.

> If they put it in writing that they will approve it like he told

me

> over the phone I'll send him the package right away. But I doubt

> it. I told them the same thing about speaking to the complaint

> investigator first and to my attorney. I also asked them about

the

> doctors/nurses not speaking good English and one guy said, " that's

> irrelevant " . I told him it wasn't irrelevant to me. He said the

> doctors and nurses read and understand English perfectly.

>

> I've got a call into both the complaint investigator and my

attorney.

>

> Barbara (Sofia DOC Grad 9-17-02 & Catalina)

[Guest guest]

Barbara,

You should probably just send in another package, but definitely get a signature confirmation that they received it!!! It sounds to me like they got the message that you are serious about this, and if you can get it approved by sending in another package, then it will be well worth it. You should still follow-up with the complaint and by speaking to your attorney, but the headache will be less if they just approve it based on your appeal. When you send it, also call the "two higher-ups" and let them know that it is on the way and you expect their approval immediately, and don't forget to document everything!

Gail

P.S. I have all of Trisha's contact info if you think you might want it.

Re: Update - Ins. Doctors don't speak English?

Thanks , Marci got in touch with me and is helping. Hi Gail,Our insurance is through my employer. The HR Director and I called Hobbs Group yesterday (they are our insurance broker)and they said they would call me back with a rep from Horizon. They did call back and the girl from Horizon said they cannot find my appeal. She also confirmed that if I were to speak to the Doctors and nurses from their medical review board that I would not understand them because their English is very bad. I questioned her about nurses because I was told doctors would review my appeal and she said that either nurses or doctors could review my appeal. I told her I did not feel it was fair that a nurse and not a doctor would make a decision on my appeal, if they ever find it! She wants me to send another package in but I told her I wanted to speak to the complaint investigator first and to my attorney.About an hour later two higher ups called me on a conference call. They started out by saying, Sorry we goofed please send us another package and we will get it reviewed and approved right away. Approved? How can they approve it if they do not know what it says. If they put it in writing that they will approve it like he told me over the phone I'll send him the package right away. But I doubt it. I told them the same thing about speaking to the complaint investigator first and to my attorney. I also asked them about the doctors/nurses not speaking good English and one guy said, "that's irrelevant". I told him it wasn't irrelevant to me. He said the doctors and nurses read and understand English perfectly.I've got a call into both the complaint investigator and my attorney.Barbara (Sofia DOC Grad 9-17-02 & Catalina)For more plagio info

[Guest guest]

Hi Barbara:

I just wanted to say " GREAT JOB " and to tell you to go for it. Sue

them. What the hell. Use that attorney, and just go for the

jugular. How dare they treat you or anyone like this. I know there

is a special hell for folks who are behind these hideous policies

that keep others from receiving health care that should be covered

with their insurance and has already been paid for by our premiums.

Good luck!

, Rhiannon's mom ( 9 months old, DOC grad, 95% correction and

torticollis RESOLVED!)

> Thanks , Marci got in touch with me and is helping.

>

> Hi Gail,

>

> Our insurance is through my employer. The HR Director and I called

> Hobbs Group yesterday (they are our insurance broker)and they said

> they would call me back with a rep from Horizon. They did call

back

> and the girl from Horizon said they cannot find my appeal. She also

> confirmed that if I were to speak to the Doctors and nurses from

> their medical review board that I would not understand them because

> their English is very bad. I questioned her about nurses because I

> was told doctors would review my appeal and she said that either

> nurses or doctors could review my appeal. I told her I did not feel

> it was fair that a nurse and not a doctor would make a decision on

my

> appeal, if they ever find it! She wants me to send another package

> in but I told her I wanted to speak to the complaint investigator

> first and to my attorney.

>

> About an hour later two higher ups called me on a conference call.

> They started out by saying, Sorry we goofed please send us another

> package and we will get it reviewed and approved right away.

> Approved? How can they approve it if they do not know what it

says.

> If they put it in writing that they will approve it like he told me

> over the phone I'll send him the package right away. But I doubt

> it. I told them the same thing about speaking to the complaint

> investigator first and to my attorney. I also asked them about the

> doctors/nurses not speaking good English and one guy said, " that's

> irrelevant " . I told him it wasn't irrelevant to me. He said the

> doctors and nurses read and understand English perfectly.

>

> I've got a call into both the complaint investigator and my

attorney.

>

> Barbara (Sofia DOC Grad 9-17-02 & Catalina)