The insurance company (IC) has given me 60 days to file my notice to appeal, so after Faxing the Notice of Payment Denial to RN, I marked on my calendar the 30-day half-way deadline and the 60-day drop-dead deadline to make sure I don’t lose my opportunity to appeal.
Awakening in the morning after an evening of July 4th fireworks and a hot dog loaded with topping, I glanced at the calendar to plan for the next BYOE (Bring Your Own Everything) dance. What I saw instead alarmed me. The 30-day half-way deadline lurked only a week away! I thought I better get RN’s status report.
I sent a message to RN through the Patient’s Portal (PP), asking very demurely about the status of our appeal. No sooner after I hit “send,” a notice that there was a new message from the PP yanked my attention. RN’s responsiveness was awesome! But my computer, my cellphone, was way too slow because I insist on not buying any more data from the provider. I could hardly wait for the next day to come for me to go to the computer room to read the message.
The message said: Hi Celia, this is Noreen (changed to protect her privacy), RN. Dr Brevity’s RN won’t be back for two weeks. Can you tell me what the denial is about so I can find it?
I was floored! It’s a good thing I’m cool. And retired. And only halfway to the drop-dead deadline. With nothing else that’s earth shattering to do, I have time in my hands to be mischievous. I responded to Noreen RN deliberately and methodically, giving her a blow-by-blow account of what transpired between RN and me. I must have given her information overload! I haven’t heard from her since.
Left to my own devices, at least until RN returns in two weeks, I went ahead and wrote a letter to IC in strict accordance with their instructions, of my intent to appeal their denial of payment.
Four days after mailing my intent to appeal, I received the SECOND denial of payment. Obviously Dr Brevity’s staff had already appealed and provided IC all the material needed. Remember, IC’s reason for the FIRST denial of payment was non-receipt of said material. Now IC has a new and improved reason for the denial! The SECOND denial letter said When you enrolled in a Medicare Advantage Plan, you selected a Primary Care Physician to coordinate/authorize your medical care. The services received were not authorized and not payable by Monarch.
I have a good argument, i.e. time frames, etc, with that reason for denial, but IC gave me a new 60-day window to file a SECOND appeal. Serious stuff! I decided to go to the swimming pool and upgrade my wading capabilities. But first, a selfie.
I’d love to hear how you handled your similar situation.
(To be continued)