Thursday, May 15, 2008

Appeal Denied

Well I got the papers in today on the bed regarding the appeal we filed and I just want to scream! It says its been viewed by a UHC Field Medical director and he made the following determination: The plan pays for Durable Medical Equipment(DME) that is:
*Ordered or provided by a Physician for outpatient use;
*Used for medical purposes;
*Not consumable or disposable;
*Not of use to a person in the absence of a sickness, Injury or disability;
*Durable enough to withstand repeated use; and
*Appropriate for use in the home.
This bed does not meet the above criteria in that it can be used by anyone. Therefore, no benefits are available under this plan.

What kind of crap is that? I am so fed up with insurance and cant wait for the July window to open up for a change to another company! Ugghhhhhh! If the insurance had all these standards they follow why in the world did they give the approval for something they had no intentions on paying? In what way is she not using it for its purpose? And the Dr. did write a script for it in which they cant even approve the bed if they dont have it. And it not being used for repeated use she sleeps in the thing every night! I am so confused???????

1 comment:

JSmith5780 said...

That just STINKS!!! Have you considered going to the media?? Our local paper has a section called The Advocate that goes after companies for things like this. It's a thought. If it's happened to you, it's happened to others. Have you talked to the Epilepsy Foundation? Maybe they can help.