Thursday, March 19, 2009

appeal appointment

I went down to our benefits office today to ask some questions about what I was needing to turn into them, and I ended up turning in my packet and getting an appeal review date. On April 30th I will be pleading my case before an appeal committee. About a week later they'll give their recommendation to the board of trustees, and then I'll be notified. I can then appeal their decision, I think, if they deny it. The could decide to pay for it in full, deny it in full, or pay for the surgery in part.

I just realized today, however, that there will be a hitch in the road: Right now I'm just trying to convince them to allow my coverage through Regence to ALLOW orthognathic surgery - just allow the idea of having surgery. In reading through other people's experiences, often insurances deny the patients the first time around, making them prove that the surgery is medically necessary. I asked the coordinator today - what happens if I get approved for the surgery to be considered, but then denied through Regence the first time? His answer? Go through the whole appeal process again.

So tomorrow I'm going to call Regence and see how they determine the surgery is medically necessary and see if I can go through that process PRIOR to April 30th so I can skip that bump in the road.

I feel like a hamster.


Melinda said...

What a run around! I hope it gets sorted out!

changes911 said...

You are having to jump through hoops of fire just to get this surgery approved. I hope that it all works out and that you dont have to change your surgery date. I am crossing my fingers for you! Good luck!!!!!!

funkyrhodes said...

Geez, that is so lame! This is power-tripping at its finest. The only advice I can give you is DON'T GIVE UP! Even my surgeon told me it was impossible after the insurance last denied me. Get as many professionals to write letters and back you up! I wish all the best! :)