Lyn Mine actually isn't an appeal. Basically was told flat out NO because of what is in our contract. The only way I could even get a written denial is if I were to HAVE the surgery, then the charges would come back denied. I don't want to take that risk....can't afford it AT ALL.
But, I for some reason just thought I would call that OMS # that came in the folder of information and spoke with the lady who did my 'case'. She said there is usually NO way to get around it "unless" my insurance may be self funded, then I can try through human resources. What the heck, I took a shot and made a call. I think the thing that is helping me out so far is that our insurance IS "partially" self funded. Then, the HR Secretary (whom I never met and lives many states away) has sympathized for my young family since originally hearing of my tumors and surgery for the AN. When she heard my explanation of the SSD, she sounded like she was in tears and vowed to do whatever she could for me. So, I refer to her like my little angel....she is my advocate right now. OF COURSE.....still no guarantee, but I have to try!!!!!
If it fails, there is one doctor more local who wants to start doing BAHA and has done none yet, so I thought 'maybe' he would work something out if I was his guinea pig
(can you tell I really need one.........more like I feel like I need one...........SSD & tinnitus just suck for me & my family so far)
I am crossing my fingers, but in the mean time I found out I have another condition that may take precedence over the BAHA. Chiari Malformation and something else, but don't see neurosurgeon to know more until the 14th....ugh, more waiting.
thanks,
Denise