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Appeal Paperwork Sent; Now We Wait

Monday, July 13, 2015



My day today began waiting.  And tonight, it ends with waiting...

As quickly as we learned that Bennett's sinus surgery would not be covered by insurance on Thursday was as quickly as I was on the phone to fix it.  

When we ran out of time to fix it, we had no choice but to go home without surgery.  I later learned that in order to submit an appeal with the insurance company, the appeal should be in writing and should include a letter of medical necessity.  

First thing on Friday morning, I called the doctor's office asking for a written letter of necessity. 
I called again at lunch time on Friday.  And then I called again at 2:30pm.  I also send 3 separate electronic messages requesting a letter or at least a phone call.  However, after my last phone call, I learned that, despite my requests, the clinic wasn't going to make available what I needed to make for a written appeal until the following week.   

So, this morning, after sending my children out with a babysitter to go to their bi-annual dentist appointments without me (she would simply have to have the dentist call me if there are any cavities), I drove down 30 minutes to the ENT clinic.  There, I intended to wait.

I wasn't willing to go on more day without being able to appeal the exemption keeping Bennett from relief and the ability to breathe again.


Early into my morning at the clinic, I was recognized.  A very sweet lady at the front desk listened to me tell her desk mate only a few minutes of Thursday's ordeal before she said, "oh I know you..." She had I had spoken on Friday afternoon.  She knew the fiasco that had taken place and my frustration of being put off longer than was necessary.

In a matter of minutes I had spoken with the nurse...and then the nurse again but with the a Resident. Both offered for me to go get coffee or go home and come back.  But I made it clear that the only thing on my agenda today was to get the necessary paperwork to submit an appeal on behalf of my son.


After 2 hours and a few episodes of the Nick Jr TV show "Blaze," I was handed the paperwork I needed.
  
The medical records I still lacked?  That would require a trip downstairs to the Business Office a drive to the main hospital's Medical Records office.  


It didn't take long to drive over.  Tucked into a small room with a dozen other people, I waited only briefly for Bennett's medical records.  I had planned to stay for a while (the morning had taken so long, surely this would too??).  But it took just a moment for them to print and for me to be on my way! 





Once I had both Bennett's medical records and a letter of medical necessity in home, I had planned to head home.  But I wanted to get this paperwork into the right hands so before I even pulled out of the hospital parking lot, I was emailing and faxing it to the right places.

While in my car, I was able to turn the paperwork in to digital copies use the app CamScanner in my iPhone.  Having the paperwork digitally allowed me to send the paperwork via email to Baylor and Academic Health Plans immediately.  Within minutes, I had heard back that they had received my appeal and were forwarding it on to the insurance company.




The other app I used, called FaxFile, allowed me to send via fax an official written appeal to the insurance company.  The appeal process allows for two appeals, a first and a second level appeal.  

So, where do we go from here?  We just wait.  The official appeal with the insurance company may take up to 30 days.  I'm very hopeful to hear something positive from Baylor/Academic Health Plans but I honestly don't know.  

Bennett asked for medicine for his headaches again tonight.  It's hard to see him continue to suffer knowing that we were just minutes from getting him relief via surgery a few days ago.  

Bennett said to me as I gave him Tylenol Thursday night after we came home from the hospital without surgery, "I thought they were supposed to fix my headaches.  I don't think that's very fair that they didn't do that." 

To which I said, "I know, buddy, Daddy and I didn't think that was very fair either.  We're working on changing that."

Now we wait to see if someone agrees with us.

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