Big bad insurance company, you pushed the wrong buttons!
Well, last Monday, I went to see my Case Manager, so she could help me file an appeal with *Insurance Company*, to get my Effexor XR back up to 150 mg. I brought her the denial letter. I think I told about the fact that they claimed they never received the information they needed till after the deadline, March 29. Which was totally not true, since it had been faxed three times, with all the info they wanted, the last time being the 13th of March, with an expedite request. Antoinette went and got my chart, and right there on top were the copies of the faxes, dates and all. She called Insurance Company, and this guy gave the third or fourth story of what the procedure was supposed to be. He said that all that needed to be done was for my DOCTOR to CALL them, and give them everything over the phone, and they would absolutely approve it, expedite it, and even if it wasn't expedited, it would for sure be approved, and within the week. Antoinette took my entire chart to Dr. Franzetti and told him what Insurance Company told her. She told me to call her Tuesday to see what happened. I couldn't believe it when she told me the next day that they STILL denied it, even talking DIRECTLY to Dr. Franzetti and getting everything they needed, right over the phone. They said that it had to be ME, and that I would have to file an appeal in a written letter. Which of course, everybody knows what the outcome of that would be. What they were too stupid to realize is that, Monday, I had received in the mail, their ENTIRE information package...something I had never received before, when I have been a member since August (not by my choice, but Medicare's). They claimed that I requested the information package, which I never did, lol. IN that information is the REAL story of the entire, step by step procedure for filing an appeal (instead of all the lies and runaround and beating around the bush that they had given me over the phone). I file an appeal in writing. If it's denied, I have 60 days to appeal again, with whatever they request. If it's still denied, my doctor does it. If they still deny it, I take it to an Administrative Court Judge. If they STILL deny it, I can take it to the FEDERAL GOVERNMENT!!! Guess what I'm going to be doing? I'm starting from the very bottom, following their procedure to the letter, and going all the way to the top if I have to. Big bad insurance company's not gonna win this one. They don't call the Strba women bullheaded for nothing. We may be crazy, but we're not wimps.
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