Back in July the CGMS was denied for me by my insurance after they stated to me they review on a case by case basis, then when I asked for coverage they stated they don’t cover that type of medical equipment and did not even give me a claim number to file an appeal. The claim # was listed as N/A on this lame denial letter.
I wrote a very lengthy letter and supplied 21 pages of literature for my appeal at the end of September and never heard anything from them.
I called last Friday and they stated they never received the appeal and I left my name for the appeal lady to call me. She never did. I called again on Tuesday and left a voice mail with the appeal lady Donna, and of course I never heard from her. I then gathered my letter and 40 pages of documentation, this time, and faxed my appeal into the insurance company and called them two hours later and no, no fax as yet, omg. Julie T. (she would not give me her last name) finally recieved the fax and said what do you know they got the mailed appeal on the same day, fancy that!!!
She told me they meet for appeals twice a month and I asked when the next one was and she stated she did not know, I said give me someone who knows that info. She put me on hold for a long time and came back that it would be in the next 30-60 days, how the heck does that equate to twice a month??!!
I have a pumper friend who stated that I can file a complaint with the state about how this insurance company is messing with me, but I think they realize there wrong doing after they finally got the mail a month later.
O.M.G. Karen, that is just SO wrong and utterly rediculous!!! Not like they’re giving you a FREE service or something! GOOD LUCK with getting approved!! I’ll be keeping you in my thoughts and prayers!!!
Good luck with getting approved but the Insurance can really reise your bs when messing with them! I have often wondered if they know that stress raises our bs! I get really discusted with them really fast! I have Medicare and after running me around in a circle for 9 months they finally approved my pump! Kill yes can I? HA!
When I have problems with companies I often do the following:
Send a complaint letter to the local Better Business Bureau.
Send a concise statement of your problem with the local newspaper(s) and investigative/consumer reporter of local TV station. You may have to send to a larger media outlet city if you live in a small town.
Have it written and sent by a lawyer (you draft it for them, it won’t cost a lot). Don’t ask them to “please inform me of your time frame”, tell them that you expect to receive your claim acceptance, in writing, by 30 days from now (specify the date, not “30 days”). And, that if they believe that they can deny this medically necessary and FDA-approved treatment, to send ALL of their decison criteria and documentation, because it will constitute evidence if you file a Civil Lawsuit. Also require all the names and mailing addresses of decision makers on your case, since they may be called as witnesses. (DO promise that you will not use their names and contact information for any other purpose).
They see a letter like this come from a law office, they’ll probably stop jerking you around.
I hope your info is well used… I can think of many situations your advice would be helpful in.
Whenever I am dealing with a hospital, nurses, etc. that are not helpful, I’ve always asked and insisted on talking to the “Administrator” ON DUTY to rectify any problems. I talk to them with respect and the matter is always resolved. Hospital’s and staff do not want a negative report that will affect their rating.
Just to lt you know, most often I have great nurses and support staff.
