Greetings Jody.....

Jody:

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Hope you are having a wonderful birthday. Wishing you a merry Christmas and a happy, healthy and prosperous new year.

Lois La Rose
Milwaukee, WI

Jody, you've got mail. :))

Sorry, Jody, not to have seen your comment on my page (December 19). Actually, Jody, I almost certainly specialize "a lot more" in winning CGMS coverage from BCBS operating companies. If your Endo's request was a PAR, and not a formal appeal, then you should ask your Endo for copies of the letter he sent and the BCBS-FL reply.

Although your Endo has lots of experience with pump approvals, he almost certainly has LESS experience with CGMS appeals than I do. So, if you really want to go after it, you should have me Ghost-write a draft of your formal Appeal letter.

I think I've explained my letter process before-- the letter will not be "professional"; rather, it will be "spitting-blood" angry. But it will also spell out exactly how another denial will threaten the career of the "deciding" MD, and this letter has never failed to win approval from a BCBS unit. (I've ghost-written a few letters for people in other States.)

If you're not willing to send such a letter, then yuo shouldn't use me. Every time DW and I go to a medical conference which includes a high-quality "legal" session for MDs, (our last one was in November), the presenter emphasizes the importance of preventing and reducing patient anger-- at nearly any cost.

BCBS appeal MD's have attended similar lectures, I'm sure. And that's why my letters always threaten to attack the personal license of the MD: To BCBS, or any huge insurance company, it's only money, and they lose lawsuits frequently (it's just a cost of doing business.) But to the responsible MD, showing that you're angry enough to maybe take it before the licensing board-- AND that you have the facts to probably make the Board agree to a formal hearing-- it's a showstopper, he/she will cave immediately.

At least, that's the way it's always happened so far. :))

Hi Jody!
Believe it or not, you are the first to ask the military question. And no, there is no military background. I was born in Savannah and have been in Columbus since I was 3 months old. I think that makes me a native, huh?

Good to hear from you...hope to see you around here...