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How long do you have to appeal?

Discussion in 'Insurance Issues' started by momtojess, Jan 28, 2008.

  1. momtojess

    momtojess Approved members

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    deleting all threads, too much cwd drama
     
    Last edited: Oct 14, 2010
  2. rickst29

    rickst29 Approved members

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    no problem within 30, or even 60 days... but her AGE could be a problem

    If you sit quiet past 90 days some insurance Co's will make you start over (completely). But a few weeks for preparing your documentation won't be a problem, I think.

    But you're maybe gonna have a special difficulty with Jess: she's not 7 years old yet. That's a possible problem area, MM CGMS is currently approved only children 7 and older (Dexcom is approved only for adults). So there could be a battle of words about "she's already competent to manage her own pumping, and there's no magical physical difference between long-standing IDDM-T1 at age 6 and long-standing IDDM-T1 on her 7th birthday. The medical necessity is already present, and she clearly demonstrates the capabilities of a "typical" pumping 7-year old to manage her diabetes."
     
  3. jendean

    jendean Approved members

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    Every time you appeal you have to get better information.
    Maybe we should all start taking our kids to the ER every time they sneeze. I think the insurance companies would take note a little more quickly if we hit them where it hurts. They cannot deny ER visits. :cwds:
     
  4. vettechmomof2

    vettechmomof2 Approved members

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    THe problem with that is unless we get admitted it will cost us $250. 00 per er visit.:eek:. Not counting drive: 45 minutes away and maybe having hubby take off of work to help watch my 3 year old then.
    They cannot deny er visits but they can still make them hurt.
    Allene
     
  5. rickst29

    rickst29 Approved members

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    Yep!

    I think you noticed, even the first draft of our appeal letter includes the specific FDA web address for the approval pdf's. Our second draft will also provide a number of journal articles Per my PM, please mail me a xerox of the entire letter, and we'll put together the 2nd draft to pass around next week-- and maybe also post here for comments.

    Other smart CWD members are watching, and can probably suggest further improvement for that draft before we send it.
     

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