So yesterday I called Anthem to check on my appeal of the denial of Eric’s pump coverage. I guess I didn’t put anything in about this, but the deal is, on October 7 his endo sent a letter to Anthem detailing that Eric’s pump is medically necessary. Having had no acknowledgment of this letter in the past 3 weeks, I called them to check on it. Was told that the letter hadn’t been sent to the Appeals Department because a specific one-page form that is supposed to accompany such letters (of which no mention was made in the description of the appeals process) was not submitted by my endo. In other words, they got the letter and filed it and didn’t put in an appeal, because the form they didn’t tell us was needed wasn’t submitted. Grrrr.
As it turned out, my call was all that was required to start the appeals process… sort of. It got the letter sent to the Appeals Department, and it got me the name of the person in the Appeals Department to whom this stuff needs to be sent. I was then informed that Anthem would still need the documentation that was originally submitted to Medtronic. So I had my endocrinologist fax those documents over to the woman at Anthem. And I had them send the same documents to me. I will follow up next week to make sure that they have all they need to start the appeals process, and if they don’t, I will take my endocrinologist’s letter and documentation and personally deliver them to the Anthem office in South Portland.
The moral of the story:
Call your insurer and ask them exactly what they need to start an appeal, and ask if there are any specific forms to be submitted (there will be). Get those forms. Fill them out personally if you can, and if you can’t, take them to your endocrinologist, have the endo fill them out. Then make a copy for your files. Then send them by registered mail, Fed Ex, or take them in person to your insurer’s office. Then follow up a week later with a phone call to be sure the process is under way.
Is it a hassle? ABSOLUTELY. But the insurance companies make it deliberately difficult to discourage appeals. Even the freaking phone tree at Anthem is convoluted! I screwed up the button pushing twice before I finally gave up and tried the “hit zero a zillion times” method (it worked).