Chris D

[Guest guest]

I agree, sometimes you have to be tenacious when dealing with insurance

companies. If you could see the amount of work on my desk right now! And it

is

difficult, because you are dealing with peoples health and their money...two

very sensitive subjects! I know for myself, and the majority of the people I

work with, we all want to do everything in our power to provide the best

customer service we can. There will be some cases that are more memorable or

pull

at your heart strings more, but the problem is... there are so many checks and

balances in the insurance industry and so many regulations... sometimes our

hands are tied. For instance, WLS is a contract exclusion for the plan I

administer. They will not approve it under any circumstances. Before I had my

surgery, I handled written correspondance, and I hated sending those denial

letters. We couldn't even send them to medical for review because MN was not an

issue for a contract exclusion. now I handle escalated appeals and i still get

these occasionally...but it is the same thing. In this case, our hands are

tied..but my heart goes out to them, because I can definately relate to what

they

are going through, and how much they wnt this! However, I tend to think of

myself as a patient advocate--because really that is our job. When I receive a

grievance appeal, my job is to check every avenue possible to see if there is

any way we can allow additional benefits, or reverse the grievance

completely--and there are times when that happens and it does feel good to send

a letter

to the member with good news on it. I just try to put myself in the other

person's shoes and do what i can. that is awesome the CSR you worked with

called to see how you were doing after your surgery

Chrissy