Insurance Denial - Gamma Knife coverage

[Eva Mitchell]

All-
We just found out today that the insurance has denied Adam's Gamma Knife proceudre set for tomorrow morning. They denied it because he has -- systemic disease outside of the brain.

Help! Does anyone have a suggetion for us? Please email me directly at mitche@seattleu.edu

We are frantic right now!

Addendum: After the surgery was canceled, and with intercession by the surgeon and insurance advocate, Adam's procedure was approved and the surgery will go on as originally scheduled. Still, we feel that at some point denial is going to happen, and we need to develop a contingency plan.

[Beth]

I have just sent an email to Eva, but I want to share my thoughts based on an experience in the past with an HMO that denied speech therapy to one of my children. I went through the grievance process which took **one year** and after that I told them I would see them in court and that is when they agreed to cover the therapy. we are dealing with a life threatening illness -- the family must raise enough money immediately to get the hospital to provide the service, and proceed with the surgery. The appeal must be made and go to the highest level which may be the state but I'm not sure if it could go further. my thoughts and prayers are with Adam and the family

[D.ap]

The above was in 2007

Because of people before us we NOW have the resources to challenge insurance companies when they try to follow OUTDATED information pertaining to ASPS.
Please as a member of the forum , keep the information coming so we all can benefit now and in the future ..