Mike: Day 61 Appeal Results

April 20, 2011

Family, Health, Mike

About an hour ago I received a call from Tammy at Highmark. She wanted to let me know that a hearing had been held yesterday regarding my appeal. Bear in mind this was a hearing I knew nothing of and was afforded no opportunity to participate in. She went on to explain that I would receive a letter.

I asked if I was able to know the outcome and she told me that the original denial was upheld.

I believe this to be due to what is an essentially flawed process. Since I made (a pretty good) living doing business and system process re-engineering, I’m pretty adept at identifying bad process! I believe that in situations such as Mike’s the picture and the medical data change rapidly. The appeal process is slow, unwieldy and certainly not fluid. The doctors appeals and the patient appeal are totally disconnected and the patient is unable to truly participate in the appeal process.

In any event. Denied he is. The nursing homes they say he should be going to are being contacted and universally declining him because of the trach and the restraints. I don’t know what happens next.



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