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Has anyone had to file an appeal to insurance for medical reasons?


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#1 greypilgrim256

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Posted 19 December 2014 - 10:24 AM

Doctor Burt at North Western has agreed to review me for possible Stem Cell Transplant.  I plan on having my rheumatologist and hopefully my Sclero specialist get on board and write letters for the evaluation, which is done at North Western Memorial Hospital which is not in my network of Blue Cross Blue Shield.   If my insurance tries to deny coverage for the evaluation, has anyone had success appealing the decision?  



#2 Joelf

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Posted 19 December 2014 - 10:55 AM

Hi Greypilgrim,

 

I'm in the UK, so can't give you any first hand advice, but we have a thread here about insurance claims for Stem Cell Transplants, which I hope you'll find helpful and informative.

 

Kind regards,


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#3 greypilgrim256

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Posted 22 December 2014 - 05:37 AM

Thanks for the link.  It was helpful.  I printed out some of the important parts.  Going to see Johns Hopkins tomorrow and will see what they say.  I am predicting that they are going to suggest I wait on the stem cell transplant, but I am going to push for the evaluation anyway.  



#4 Shelley Ensz

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Posted 29 December 2014 - 12:24 PM

Hi Grey,

 

How did things go at Johns Hopkins?  Did you have a chance to cover the question of stem cell transplant? 

 

:emoticons-group-hug:


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#5 greypilgrim256

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Posted 01 January 2015 - 09:53 AM

Hi

It went well. Dr. Hsu at Robert Wood Johnson diagnosed me with diffuse.

Dr. Ami Shah of Johns Hopkins said I have Type II limited, and I'm not sure what that means.

She said she did not find any evidence of tightening on my chest or past elbows, so I am assuming that is what she means. She recommended doubling my dose of Methotrexate but said that Stemcell transplant would  probably be too extreme of a solution as of right now.

I highly recommend Johns Hopkins though. Dr. Shah was fantastic. Very methodical, kind, and informative. She spent about 2 hours with me going over everything.



#6 Joelf

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Posted 01 January 2015 - 09:34 PM

Hi Greypilgrim,

I'm very pleased to hear that your appointment at the John Hopkins went well and it is such a comfort to have a medical team in whom you can have confidence.

Here's hoping that this will be a good start to the New Year for you. :)

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#7 Shelley Ensz

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Posted 04 January 2015 - 04:06 PM

Hi Grey,

 

I'm delighted that you were happy with your care at Johns Hopkins. They are an excellent scleroderma center.  And it is *always* a good thing to not be in immediate need of a stem cell transplant, isn't it? 

 

There are many different ways to categorize systemic scleroderma.  Some doctors define skin tightening only above the elbows as being diffuse whereas others use the above-the-wrist definition, although many other factors also come into play in determining a particular category.  Very often, patients aren't even told their subtype, and even when they are, it is sometimes subject to change, for example, if the skin tightening progresses.  See Types of Scleroderma section for more info.

 

:emoticons-group-hug:


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Shelley Ensz
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The most important thing in the world to know about scleroderma is sclero.org.

#8 Amanda Thorpe

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Posted 07 January 2015 - 02:28 PM

Hello Greypilgrim

 

Now you have had the stamp of legitimacy on your forehead! There's no going back now!

 

Well, with limited scleroderma you will be pleased to know that it is slower in onset, slower in progression and more favourable in outcome than diffuse. However, being scleroderma it can still be like handling a bag of snakes and is no walk in the park but you now know where you stand and have a good medical team behind you.

 

Take care. 


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