- my thoughts concerning letter

[Guest guest]

Hi ,

I am so sorry that things are not getting much better for you. But I

also want to second a lot of the advice that you have received

here and on other forums about trying your hardest to make all of

your appointments. I know from the provider's point of view,

patients that consistently cancel or are " no shows " (those that do

not cancel but just don't bother to show up) are dropped. An

example that occured recently at my clinic is four out of four

patients did not show up for a Thursday clinic, after the doctor,

who is out on medical leave after having surgery to remove a

malignancy, made a special point to come in that day just to see

these patients. Understand the displeasure that we all felt

towards these patients.......for being so discourteous after the

physician made a personal sacrifice to be there on that day for

them and watching him struggle with his pain. I guess my point

is, you have to understand that physicians are human

too.........And of course, the reasons that have been mentioned

are also very important: to establish compliance, to let your

doctors see you during your worse times and to establish trust. I

am sure you get the point.

As far as your letter.......in my oopinion only....I would approach

this from an objective, dispassionate view. I would take all the

paragraphs / sentences that were written in the denial decision

and refute them one by one. For example: if they mention that

your imaging studies are not consistent with a disability quote

that sentence (or paraphrase it) then counter it by stating why

imaging studies are unreliable...I would also include references

to published literature and when / if possible, supply them with

copies of the literature. I would do this in a step by step process

for each point that was made in the letter.

Then at the end, I would include a more personal, impassioned

statement of what the illness has done and is doing to your

ability to hold down your job. Again, you can include references to

the effects of the medication that you are on as well as the most

likely progression of the disease.

While I understand your frustration, anger, disappointment and

desire to strike out......I think that if you write a letter that is too

emotional and has a tone of wanting to criticize and humiliate the

decision maker, you are going to run into defensive and

stubborness on the part of the claims processor. You want to set

the tone of conciliation and teamwork......make it seem as if you

are willing to provide them with sufficient and necessary

paperwork and information.

If you need copies of any references to include in your letter

please let me know and I think I can email them to you. Or I can

mail them to you via USPS.....I do not mind doing this at all. But I

really think if you write the letter more on the line of a " research "

or " term " paper, you will have more success in making them

change your mind. I am willing to help you with this in anyway

possible.

Laurie