Insurance "Lost" our appeal

[cobbiemommy]

I called our advocate to check on the status of our appeal. The person who answered the phone was not sure and called the insurance company. The insurance company lost our appeal paperwork. Needless to say, the advocate faxed it again, but she said the process begins again with today as day 1. How is that possible?

 

This is the same company that "lost" our precertification paperwork and then refused to pay for three HD IVIg. Also, they wanted to reevaluate going forward whether he still needed IVIG. I am beyond angry. I feel like our family is being hit twice: once by the illness itself and then by the insurance company denying benefits. This doctor is in network with our insurance company, so I am just stumped what to do next.

[JAG10]

Well......I'm glad they lost the paperwork rather than you lost the appeal, which is what I thought at first glance.

I'm becoming so distrustful of the whole system. I just don't know what to think about any of it anymore.

[tpotter]

I also thought you lost your appeal. But, that being said, I don't know what to say. What does your advocate say?

[cobbiemommy]

The advocate says that this is a common practice. He did tell us "Do not call the insurance company and complain." Despite my temper, I have not called. Whew! The advocate has everything well documented and if it goes to government review; it will really make the insurance company look bad (or in my opinion, deliberately incompetent).

[LNN]

Maybe in addition to faxing info, send it by certified mail/return receipt. That would give you a signature from the insurance co. and a date so maybe you could argue that the clock shouldn't get re-set every time they "lose" something.

[cobbiemommy]

Maybe in addition to faxing info, send it by certified mail/return receipt. That would give you a signature from the insurance co. and a date so maybe you could argue that the clock shouldn't get re-set every time they "lose" something.

They had confirmed receipt of the documents each time (three), so I don't see how they have a leg to stand on either, but I'm not a lawyer. Advocate says that insurance companies do it all the time. I wish I still had my rose colored glasses on how life works! Ignorance was definitely bliss.