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Denied...Need help with appeal please!!

Discussion in 'Insurance Issues' started by Jfoxsmom, Apr 10, 2008.

  1. Jfoxsmom

    Jfoxsmom Approved members

    Joined:
    Mar 3, 2008
    Messages:
    6
    Just got our letter from Great West ...Denying Jamieson's pump due to c-peptide levels being in the "normal" range..

    Our doctor wrote out his 1st appeal letter clearly stating that the c-peptide test should not be conclusive since the pancreas could "smolder" for years...and yet they ignore what he says...

    Now Jamieson's A1C is 11 ... and his blood sugar is like a roller coaster, it's not that he doesn't take care of himself....he is currently going through puberty and everything is out of whack..may God have mercy on me.

    Can someone give me some pointers about how this thing should look and even possibly point me in the right directions for articles that show c-peptide levels should not be the "end all" to determine if my son needs a pump?

    Any help is REALLLLY appreciated!
     
  2. Jfoxsmom

    Jfoxsmom Approved members

    Joined:
    Mar 3, 2008
    Messages:
    6
    Hurray!!!!

    Got word today from Great West rep....who apparently got a call from my hubby's employer (a wonderful outfit out of Texas --- Maryland/Higman Marine)....Great West was told by the company to "buy the pump" and the company itself will pay for it...Great West was told to only "broker" the deal!!!

    My son is off the wall excited!! :)

    (and so am I )

    Prayers finally answered!

    Thanks to everyone here...reading all the forums was a tremendous help..it let me know we were not the only ones having to deal with pencil pushing bureaucrats..
     
  3. GaPeach

    GaPeach Approved members

    Joined:
    Dec 29, 2007
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    2,218
    Awesome!

    I can't believe that his A1C did not qualify him. I guess insurance companies don't mine paying for the complications instead of preventing them with good d-management.
     
  4. SaltyAndSweet

    SaltyAndSweet Approved members

    Joined:
    Mar 4, 2008
    Messages:
    13
    WOW!! Congrats are in order!

    I have still yet to go through my final appeal. But you have given me hope! I am going to let my boss know what's going on... doubt my company will be as nice as your husband's. fooey!

    ~oh how are the supplies being paid for? Will GreatWest pick them up? I wonder if I could buy my own pump if they would cover the supplies.

    So good to hear good news!
     

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