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Update on Gwennie's denial~

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Comments

  • Glad to hear you've finally been able to speak w/ the facilitator and get that burden off your shoulders. I'm confident you'll do fine and will be thinking of you on the 5th.

    P.

    Edit - just saw your reply to David, I agree that your rights appear to have been violated, can you contact the office that governs HIPAA concerns in your state and see if this is the case? If they have violated your privacy, it may work to your advantage where they'll have to approve the surgery to avoid a run-in w/ the government.
  • Now you know how this team will meet and that your input will be vie tele-link, you can prepare for it.
    You are extremely knowledgeable Gwennie and are in a much better position to speak up and fight this than most people.
    I suggest that you prepare a sheet of questions and things you want to say.
    Have plenty of paper by you to make memory jogs on things they mention, so you can refer back to things you don't agree with., or things you want to clarify.

    If anyone can fight this Gwennie, you can!
    You tell it to them! I expect they will remember your case in the future as that lady who knew what she was talking about and convinced us that she needed her surgery. :D

    Go Gwennie!!!
    You can do this!
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  • I'm sure your husband will cover all these bases, but you need to get to the heart of why they are denying surgery. If you policy covers this type of surgery then they must have a reason for saying they won't. Is it your need, their coverage or that the surgery is "experimental".

    If you get to the heart of their denial it should be easy to show their error. As far as the independent that is pretty common. That person is supposed to be your advocate and should have some experience in being denied benefits. You probably have the right to have that person removed from the panel but not a good idea since they probably lean in your favor.

    So on to more important things -- since we will all be with you in spirit will you have lunch for us?? at least some cake and coffee??? lol
  • Gwennie, you can do this! I am confident in your abilities!

    My case was on a smaller scale, but once I was able to speak to my reviewer directly it became personal. I was able to report all of the conservative treatments I had. (and I have had many) I was able to talk about my steady decline, my inability to work, my history of falling, my loss of bladder function due to pressure on my spine which included ER records and their assessment of my loss of lower extermity function (there is a test they do in the ER that no one should ever have to have twice :0 ) and I graphically described it to make her squirm!

    I think you have got this in the bag. It is sad that it takes this much of your time and effort when you could be healing by now. But everything happens for a reason and keep your faith!

    I'm with Kris, we will look forward to cake and coffee with you on the 5th! Or, since it is Cinco de Miyo, down here in the south, how 'bout a margarita and some chips and salsa!!

    We are all with you! You've got this and we look forward to celebrating with you on the 5th!
  • Gotta be Tequila!!!
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  • Try to have Dr in on teleconference if possible! GOOD LUCK!!!!
  • Chips $3.00
    Salsa $3.00
    Margaritta Mix $8.00
    Patron $40.00
    Celebrating Gwennie knocking their socks off? PRICELESS!

    YOU WILL BE FINE GWENNIE!

    All in God's good timing!
  • im hoping for the best for you on the 5th. you have gotten some great info from people on here who care,only thing i can add is, do not let them control the interview process. make sure you are given the oppurtunity to state your case why this surgery is needed. got our fingers crossed for you.
  • I hope you have what was meant to happen without these who are denying your surgery. Sorry for your suffering while awaiting to get this surgery. I hope there is no further nerve damage for them to prolong the wait for your surgery. Let them know of the numbness and possible nerve compression being compromised while waiting for this surgery.

    I know they don't consider pain to be a reason for surgery but numbness and nerve compression is a reason for surgery and they have stopped you from healing in time. I hope there is no nerve damage for you having to wait. I think this could be a lawsuit against them for prolonging your surgery. I hope you get approval and praying this will happen May 5ht. Best wishes. Charry
    DDD of lumbar spine with sciatica to left hip,leg and foot. L4-L5 posterior disc bulge with prominent facets, L5-S1 prominent facets with a posterior osteocartilaginous bar. Mild bilateral foraminal narrowing c-spine c4-c7 RN
  • you Gwennie.
    It does sound like your symptoms are getting worse :-(
    If there was nerve damage due to this denial and the waiting, would these appeal people be responsible? If there are now lots of denials, will the future bring law suits??

    I wonder if the appeal panel would react if they realised that your neurological symptoms were increasing, and that they might be responsible for permanent damage!

    Hope that you managed to relax at the weekend. How are you doing?

    Thinking of you :-)
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