Re: FG, Ins, and the MGB

[Guest guest]

:

I am in the same boat you are. I am on my second appeal. I am

supposed to have an appointment with the grievance committee the

first week of June. They haven't sent me my letter of confirmation

yet. I had my hopes up because they said a medical professional

specializing in the field that you wanted surgery for would be on the

committee when it reached this point. Well, I found out today that

is not the case because the " Insurance Company " has already decided

it was excluded and therefore not covered. The greiveance committee

will be made of lay people to decide if what I am asking for is not

really included in the exclusion. I am hoping I can prove that

morbid obesity is different than obesity which is what was excluded.

I am supposed to bring anything to the hearing with me that I want to

them consider. Does anyone have any ideas. I have all my PCP's

support letters and Dr. R's insurance denial letter. If anyone went

through this let me know. I may walk up the steps instead of taking

the elevator so that I am huffing and puffing when they interview

me. Maybe I will scare them into approving my claim. I went to my

first clinic on 2/19 and have been fighting ever since. Thanks for

listening. Rozycki, Denver, NC

[Guest guest]

Hey , I know what you mean---it's not our nature to write down

people's names when it appears that all things are running smoothly. But I

guess we really need to be cautious about everything, even when it appears

that things are going off without a hitch. It just ticks me off that " big

brother " is holding the ticket to our life. All we can do is pray that

either the insurance comes through, or we receive some sort of financial

windfall, or be able to borrow the money at a low enough interest rate with

small payments that we can handle. Ask your doctor if they would send the

letter registered/return receipt mail. I still haven't heard from my HR

contact, I am going to call and bug her again tomorrow. I at least need to

know how soon they will make the decision. All we can do is take it in

stride. :-)

fg

At 07:36 PM 05/11/2000 -0000, you wrote:

>Dear FG (after all this time I still dont know your real name..LOL)

>

> No, you know it's kind of strange that I DIDN'T get their

>names. Everyone was always so friendly and happy I didn't see any

>reason to do that. I usually get people's names when they start

>getting mean and nasty with me, but that wasn't the case. I am so

>sorry about your insurance giving you a chance to begin with. I know

>what you say about the surgery not really being a problem but the

>'what-after' that could be kind of spooky. was kind of in the

>same pickle as you, I believe, with the same fears. I just got

>finished talking to the insurance co. and they still have not

>received my PCP's letter saying this surgery was medically

>necessary. After talking with Karla this morning in chat, I wonder

>if there is any hope what so ever in getting them to pay for this. I

>talked with my husband this afternoon too, and he said there is no

>way that we can afford to do this out of pocket.

> I guess we will have to keep our faith up and keep praying for

>the right answer to come. (it's just hard to accept when it's not

>the answer we want, but the one that we need). Take care and keep me

>POSTED on your progress!

>Love,

>