We Won On Appeal ;o)

[Guest guest]

Hi everyone --

Sorry for the cross posting but I had to share some WONDERFUL news! First

I'll give a little bit of background again. is now 21 months old.

She's had her g-tube for a little over a year now. She has basically been

100% g-tube dependent for feedings and has required an elemental formula for

her feedings.

We have been appealing to the insurance company for the past NINE months to

have them cover the costs of the Neocate since it was her sole source of

nutrition and because it was delivered via her g-tube.

Well, today we had our second level appeals review committee meeting. This

is the first time that we actually got to meet in person the review board and

present " our case " to them. It was not a legal proceeding but rather an

arbitration meeting with a group of independent consultants.

After 20 minutes of being able to tell them the whole story, letting them

meet , and having one of her specialists involved in a conference call

to answer any questions, they voted. They unanimously approved the formula

for coverage as well as making the coverage retroactive!!!!!! HOORAY!!!!!!

That means they will reimburse us for everything we've spent so far and

continue to cover it for as long as she needs it into the future.

So to everyone out there who are dealing with insurance issues, just keep on

persevering! Miracles do happen!

Take care!

Cindy -- mommy to 6, 5 and (21 months, FTT, 100% g-tube

fed with Neocate, chronic intestinal inflamation, SID, hypotonia, but getting

cuter all the time!)