Re: I am so upset - Chrissy

[Guest guest]

Chrissy,

I know this news is unsettling to you, but I know that you can beat this

problem, too. Someone else in the group had an initial turndown by their

insurance company, and was able to get enough proof to prove that it wasn't a

premature decision.

Yes, you do need a case manager to help you fight this through, somehow I

thought you already had one. You're with BC/BS, right? I'm surprised that

they hadn't already assigned one to you. I'd give you mine, but she's never in

her office and is not too prompt most times to return phone calls from the

doctor's offices, so I don' know if she's really going to do you any good, LOL!

I

don't have any problems with her personally, and she's prompt with her return

calls to me, but I'm just the patient.

What the case manager will do is collect all your history, etc., and she/he is

supposed to expedite any requests for surgery, new meds, new treatment,

facilitate if you have a problem with claims, go to bat for you if you're

needing

a new medication that the company doesn't want to cover, or, in your case, go

to bat for you about getting coverage for a procedure that the insurance

company doesn't want to pay for, etc.

The insurance company assigned me a Case Manager about two years ago,

and she really has helped me a lot. I don't know how or who files the claims

for employees there at the hospital, but you need to make sure that each and

every bill for everything you've ever had done, every appointment, test,

hospitalization, procedure, etc., has been forwarded through to the insurance

company. I can't remember how long ago it was that you had your last

procedure, but it could be that there are still some, or many, claims that

haven't even been filed yet. My hospitalization in Hilton Head didn't go

through the books at the insurance company main office until more than 8

months after I was hospitalized.....it could be that they are still missing some

of

the major stuff.

You know well that they've done all they can surgically to " fix " you at MUSC,

and then the doctor did tests and everything else up in Cinci, so it sounds to

me like the insurance company hasn't received the truckloads full of

paperwork all of those procedures, surgery, follow up visits, etc. that they

should have. I truly do think that that's all it could be. So all that stuff

has to

get dumped on the desk of some reviewer up there in Columbia and it will all

get worked out. And when you find out the name of your Case Manager, you

need to call them and sob your heart out and tell 'em your story. It will get

worked out. There's also a form you have to sign, accepting the case

manager, but I imagine that could be faxed back and forth to save time. If

there's anything else I can think of, I'll let you know.

Please try not to worry about this. I know that's impossible, and that you are

and you will, but I do have faith in the thought that it's going to get worked

out

and that everything's going to be okay. There's just going to be a lot of last

minute running around and paper shuffling and phone calls, and that's

probably the very last thing you need right now. Wish I could make it all

better

for you, but the paper pushers keep getting in the way.

Talk to your people up there on Monday and then get back to us and let us

know what they say. I think once everyone up there gets moving on this and

gets the paperwork heading in the right direction, it will work out and you'll

be

getting aboard that airline just as planned.

Just give all the bats a kiss goodnight and get some sleep......these problems

will go away. If you want someone to talk to about it, give me a call

tomorrow,

I'm going to be home all day.

With love, hope and prayers,

Heidi

Heidi H. Griffeth

South Carolina

SC & SE Regional Rep, PAI

Note: All comments or advice are based on personal experience or opinion,

and should not be substituted for consultation with a medical professional.