Hi everyone,

I am new here and just following yor thread. I have experienced denials from my insurance also BC/BS HMO I have another name for them too! My husband is employed by local hospital where I have been treated. Nurses in general say that the insurances automatically spit out a denial without any consideration or even looking at it for that matter. The second response sent gets put in another slot. The nurses told me to pe persistant. I did an appeal for out of network surgery and won. It is dificult to do because I was heavily medicated and in a lot of pain at the time. I made points at the insurance of how they approved my SCS trial in network that cost 37000.00 and it was not guaranteed to work, but they would not approve a 12000.00 surgery that was likely to work or hekp considerably. I also faxed 3 hrs of medical records, 2 drs letters and photos of my RSD. The appeals specialist said i won because they had so much info. The appeals physician in midwest wrote a very short you better reverse your denial. Insurance co's are only willing to agree when they feel you might have something to bring against them. When they turn you down they are hoping that you will go away and sadly they win to much.

If anyone would like to see my letter or have a copy I would be more than happy to share.

I hope this was helpful. Knowone should have to go through this process.

fondly
debbie