insurance

[Guest guest]

I’ve felt sick as, as, well there’s no word for it, but felt lymie lately.

Yesterday I was a vegetable and couldn’t even sit at my computer, but at least I

can today. Who knows what tomorrow has in store for me!

Anyways, I’m here writing because I thought you might all be interested in this

lovely letter I received today. Enjoy! I hope it humors all of you that Oxford

states they are denying treatment that is treatment that I wasn’t even asking

for!

“The Oxford Health Plans Grievance Review Board has completed its review of the

grievance you submitted requesting pre-certification for additional intravenous

anti-biotic (anyone ever see a hyphen in antibiotic?) therapy in the treatment

of symptoms reportedly associated with Lyme disease.

After thoroughly considering all of the information available to it, the Board

has upheld the denial of coverage for the treatment in question. The Board very

much regrets that it cannot provide you with a more favorable response.

However, the records provided do not show that continued therapy is Medically

Necessary, as the term is defined in the Oxford Certificate. Please be assured

that this matter was given a thorough review by an infectious disease specialist

(steere?). However, our consultant found that, while the results of the western

blot and ELISA are markedly positive, ten weeks of intravenous anti-biotic

therapy (over a year ago, and not by Oxford) has been administered and there is

no evidence of active infection. The consultant further states that continued

antibiotic treatment is not indicated and this risks (i have lyme and even know

that isn’t proper english) of therapy outweigh any benefits. Accordingly, the

Board believes that coverage was appropriately denied.

If you disagree with the Board’s decision, you have the right to either file a

written appeal to the Grievance committee of the Board of Directors, or

alternatively, the right to appear at a hearing before a committee to present

your case. If you decide to take one of these options, please notify me in

writing within 30 days of your receipt of this letter. If you request a

hearing, a representative of the committee will notify you directly with the

time, date and place of the hearing. If you wish to file an appeal solely in

writing, you should submit an appeal letter to my attention and include any

additional facts you believe are relevant. I will then forward the matter to

the Grievance committee for consideration.

Sincerely, (I don’t think she’s sincere!!!)

J.

Senior Grievance Associate”

If the morons actually read my appeal, they would realize that I am not even

asking for IV therapy, which they state they are denying. Also, if they read my

doctors reports, they would have seen I’m too ill to appear for a hearing! Did

they also not see the pages and pages of evidence? They don’t believe in Igenex

testing, LUAT, and so on. The evaluation by neurologists, infectious disease,

cardiologist, psychiatrist, rheumatologist, and so on are not enough? Anyways,

a very nice lady at the attorney generals offices (with whom I’ve filed

complaints) contacted me and said she is contacting Oxford. We’ll see. My

congresswoman also sent me a letter that she is calling Oxford. I get so

aggravated too cause I don’t even think this is the treatment I want anymore.

We will be changing treatment again, and do I need to go through all this again

for the next prescription? It is likely I will switch insurance companies, but

I first want to screw Oxford over any way that I can! The criminals.

;o)

da goose