[Anonymous August 27, 1998 at 11:53 am Post count: 93172]

#1148146

I haven’t had this problem, so I don’t really know what you can do. But, it sounds like, at this point, you should get a lawyer involved. I would think that if it went to court, and assuming you won, the insurance company would have to pay your lawyer’s fees.

Also, have you contacted your state’s insurance commissioner? I don’t know if they can do anything, but you never know. Maybe the insurance company would be more cooperative with a government agency involved.

[Anonymous August 27, 1998 at 1:18 pm Post count: 93172]

#1049941

Does anyone have any suggestions in getting their insurance company
to pay for any specific eye surgeries related to Graves’ disease?
(i.e., decompression surgeries, etc)
I received a letter
on 8/7/98, that I have exhausted all of my appeals and everything has been denied.
(It is funny, I have not received any prior denials from them their medical
experts opinions, nurse utilization reports, etc for why when ones’ vision
is threatened.) I have written letters with no response to the CEO, EVP, three groups
in Washington, D.C.(both of whom get paid in excess of 10 million dollars not counting
stock options) plus dealing with the insurance company staff too.
They have indicated “they are not medically necessary.”
Three surgeries were done on an emergency basis..They were pre-certified
Plus my insurance is a “self insured plan” meaning my employer
administers the payments. I have written letters to 4 Regional Directors in my
office too and still nothing..Maybe this is the first case they have had but
still how can someone with a conscience sit behind a desk and say surgeries to
preserve your eyesight “are not medically necessary?” Eyes are a bodily function for survival.
It is a shame to put anyone through this..its bad enough to war on with this disease but
to have to deal with insurance problems too..

Thanks for listening,
Dee

[Anonymous August 27, 1998 at 2:05 pm Post count: 93172]

#1148147

Dear Denise:>}
Hi Denise ,how are you doing these days? Besides still fighting for your rights,man they **** me off PEOPLE or should be saying COMPANY’S. Anyways ,what about getting the papers involved wherever it is that you live ,let them do a whole story on the downside of what a person has to deal with on top of being sick and the fact that your sight could be at risk here,sounds good ,give it a shot —ya never know Denise,take good care of yourself Denise,love little warrior Barb

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