Appeal denied, peer to peer review not allowed, only option left is a "member grievance" process.
Hello,
I am having an operation done on my face.
I am getting all operations covered by insurance, except they're denying my claim on an eyebrow lift and a forehead lift. The only reason I'm getting those two procedures done is because I'm having bone removed and my face will sag otherwise.
They claim the brow and forehead lift are on my employer's exclusion list. But if I don't get them done I'll look like a freak of nature.
My appeal got denied, same reason, exclusion list.
My insurance does not allow peer to peer reviews for exclusion list items.
The last option offered to both me and my doctor is to submit a "member grievance". My customer service rep told me to, "Send a letter requesting a review," and said that I'd personally get a chance to state my case before the Board. But when my doctor called and asked for him to send in the review they called it a member grievance…
So it sounds like it's a formal complaint, and I was told formal complaints waive my right to an appeal.
Am I fucked basically? Or is the member grievance worth it? I supposedly will meet personally with the Board to state my case, but I'm not a doctor, so what the hell does my opinion matter?
submitted by /u/FromRussiawPronouns
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