Guest guest Posted May 5, 2000 Report Share Posted May 5, 2000 I am mad and sad, I just sent in my 2nd level appeal to Healthsource. I called to verify they had it and they do. The person asked me if this was another " Rutledge " appeal and does he tell all his patients to appeal. I felt at that point I was doomed no matter what else I included with Dr. R's info. She said she already knows what his appeal says because he sends the same for everyone. I told her I was advised that at this level the appeal is supposed to be reviewed by a " blind " panel included on the panel is supposed to be a specialist in the field of surgery that was denied. She told me becuase it was an exclusion and not a medical necessity a Dr. would not be looking at it. I am sorry this is so long, I need help. I asked how can it become medially necessary if a Dr. never is part of the appeal. Did anybody win on appeal when their policy listed WLS as an exlcusion. I can't afford to self pay and even if we could, complications (if any) would be excluded. That is just a chance my family can't take. Also, when I mentioned they overturned for other with Healthsource, she became very annoyed and wanted to know how I found out confidential information. She wanted to know if Dr. R told me. I advised her we have a great support group and find out a lot about each other and I had some kind people share their sucess stories with me. Thanks for letting me vent. I had my hopes up that this would work, now they are dashed again. Rozycki, Denver, NC MGB hopeful since 2/19. Quote Link to comment Share on other sites More sharing options...
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