I haven't been posting as much as I used to, because I have made it my full time job to get approval from my insurance company. As my ticker indicates, I've been fighting for a long time. They have consistently given me false hope. (Well, if you send this in then... O.K. now send this in then) Time after time, I met their requests. When they didn't have anything else to complain about, they gave the typical parent response, "no, because I said so." No rhyme, no reason.
My doc has appealed to the insurance company twice. I filed a grievance...denied again. I filed an appeal with the Plan Administrator, which is the human resource lady at my husband's job. All denied.
Contacted my state insurance board....they say it's a self administered plan, so they can't help me.
Contacted the Labor Board, benefits section, and they say the same as insurance board.
My only recourse now is to sue them in civil court under ERISA.
I see an attorney on Monday. For those that don't know about ERISA, it is a federal act that governs benefits. Health benefits, disability, pensions, etc. The only thing that can be awarded under ERISA is to have them grant me the surgery and attorney fees. No damages (pain and suffering, punitive, etc.)
I have kept a binder of everything that has happened over the last year. Once my court case is over, I will post it. (Well, some of it...it's over 200 pages long).
I want others to see that this is worth fighting. I may not win in the end, but at least I can say that I gave it my all. My health is worth fighting for.
I don't know how many others have faced a similar challenge with their insurance being governed by ERISA. It's a tough hill to climb, but the reward will be sweet.
I haven't been posting as much as I used to, because I have made it my full time job to get approval from my insurance company. As my ticker indicates, I've been fighting for a long time. They have consistently given me false hope. (Well, if you send this in then... O.K. now send this in then) Time after time, I met their requests. When they didn't have anything else to complain about, they gave the typical parent response, "no, because I said so." No rhyme, no reason.
My doc has appealed to the insurance company twice. I filed a grievance...denied again. I filed an appeal with the Plan Administrator, which is the human resource lady at my husband's job. All denied.
Contacted my state insurance board....they say it's a self administered plan, so they can't help me.
Contacted the Labor Board, benefits section, and they say the same as insurance board.
My only recourse now is to sue them in civil court under ERISA.
I see an attorney on Monday. For those that don't know about ERISA, it is a federal act that governs benefits. Health benefits, disability, pensions, etc. The only thing that can be awarded under ERISA is to have them grant me the surgery and attorney fees. No damages (pain and suffering, punitive, etc.)
I have kept a binder of everything that has happened over the last year. Once my court case is over, I will post it. (Well, some of it...it's over 200 pages long).
I want others to see that this is worth fighting. I may not win in the end, but at least I can say that I gave it my all. My health is worth fighting for.
I don't know how many others have faced a similar challenge with their insurance being governed by ERISA. It's a tough hill to climb, but the reward will be sweet.