Health Organization for Pudendal Education

Tracy,
It's not a block wall, I have actually never lost a fight with an insurance company once i get fighting.
I am still not doing anything about my own situation because i am waiting on the Doc to see if he can rsolve it before I take the fight on myself.
If I have to do all that work, which is probable, I'll PM you whatever I send them so that you know how to do one of these $%&$#^@! appeals. I hope it doesn't come to that because they are a pain, but I'll bet that's exactly what happens.
Tips:
-everything must be in writing, the phone is just a stalling thing that they do because they know that if they don't get a written appeal within the specified number of days (45 for my insurance), you lose.
-The basis they are rejecting you on is a written policy of some kind. Have them direct you to the exact written clause under which you are being denied, and write your appeal. and provide documentation, specifically to refute that the clause applies to your situation.
There is a further level of appeal: there is a State regulatory Board. take it up the chain of command all the way.
Nice to know I have company! Not! I'm sorry you are having trouble too

Great ideas HerMajesty!!!

I didn't know there was a small window to appeal. I will get started on that tomorrow. I'm sure there are procedures to follow. I'm so glad you are willing to share your knowledge. I truly just wanted to crawl into a hole and cry today. It sucks to get your hopes up just to have them dashed by a pencil pusher. I will not let them win though...I just may need you guys to remind me of that lil fact every now and again.

Thank you all!!!

Tracy

HerMajesty wrote:Tracy,
It's not a block wall, I have actually never lost a fight with an insurance company once i get fighting.
I am still not doing anything about my own situation because i am waiting on the Doc to see if he can rsolve it before I take the fight on myself.
If I have to do all that work, which is probable, I'll PM you whatever I send them so that you know how to do one of these $%&$#^@! appeals. I hope it doesn't come to that because they are a pain, but I'll bet that's exactly what happens.
Tips:
-everything must be in writing, the phone is just a stalling thing that they do because they know that if they don't get a written appeal within the specified number of days (45 for my insurance), you lose.
-The basis they are rejecting you on is a written policy of some kind. Have them direct you to the exact written clause under which you are being denied, and write your appeal. and provide documentation, specifically to refute that the clause applies to your situation.
There is a further level of appeal: there is a State regulatory Board. take it up the chain of command all the way.
Nice to know I have company! Not! I'm sorry you are having trouble too

Good grief! Insurers in the U.S. must be spending way more money on their bureaucracies than on medical procedures! And they say that universal health care is too expensive??!!

I just started a bit of online research looking for backup in the literature. Here is the 1st abstract I found; will keep looking and post more as i find it:
http://www.ncbi.nlm.nih.gov/pubmed/12362115

This article is cited in numerous secondary sources as the anatomic proof that the pudendal nerve can run through the piriformis muscle can hence be entrapped there. While it does not discuss the efficacy of injections, I think based on the wording of the denial, the first step is proving that pelvic pain syndromes can be created by entrapment of the pudendal nerve in the piriformis muscle. From the info cited in other sources, this article appears to support that well. However it is only available online fo a $60 fee so i think I will try the old fashioned library method first:
EW Retzlaff; AH Berry; AS Haight; PA Parente; HA Lichty; DM Turner; AA Yezbick; JS Lapcevic; and DJ Nowland
The piriformis muscle syndrome
J Am Osteopath Assoc, Jun 1974; 73: 799.

Dr. Filler also has this case study supporting pitriformis injection for relief of pudendal symptoms; still not botox but on my way to building a case piece by piece:
http://www.nervemed.com/news/november-2 ... e-syndrome

...and another botox / piriformis abstract:
http://www.ncbi.nlm.nih.gov/pubmed/12447093

This one I could only find in PDF so it is attached

might be helpful...
http://www.internalmedicinenews.com/sin ... 5f28f.html

WOW HerMajesty!! You are simply amazing!!!

That was just an hour playing around with Google. Now to find out if there is a real medical library in this not-too-intellectual town. With Biological Abstracts and a collection of Journals. That's for after Easter though; I hope everybody has a happy one