Welborn Health Plans Attn: WHP Appeals Committee 101 S.E. Third Street Evansville, Indiana 47708
Re: Angela Spindler ID# 10004413202 Reference # 111510047731
COUNTRYMARK COOP-3809 Group # 000816000
To Whom It May Concern,
Please accept this letter as my appeal of Welborn Health Plan's decision to deny coverage of whatever procedure or procedures may be necessary to correct congenital abnormalities in my cerebral vascular system.
Based on your letter of denial dated November 17, 2010 this procedure, referred to only as PLACE CATHETER IN VEIN, has been denied for three reasons:
1. medically unnecessary 2. lack of clinical information 3. out of network
Malformations found in my vascular system thus far include abnormal internal jugular valves, stenosis in the right internal jugular vein, reflux in the deep cerebral veins, and significant collateral vessels indicating additional stenosis.
Dr. Kevin Sullivan, M.D. of Atlanta Access Care, specializing in all aspects of arteriovenous malformations believes I will benefit from correction of these abnormalities. Please see the attached letter from Dr. Sullivan.
Also included for your consideration are a list of symptoms, a report by Dr. James Lingle, M.D. on my most recent Doppler ultrasound, excerpts from relevant medical publications and a cost analysis illustrating savings of procedure vs. prescriptions.
As for denial due to network, short of scheduling appointments with each of the doctors contacted I see no time or cost effective way to prove going out of network necessary. I can however report the use of both St. Mary's and Deaconess' physician finder services as well as many cold calls made since April 2010.
With the exception of Dr. Neil Troffkin, M.D. who performed an angiography and venogram on May 14, 2010 all others directed me back to my neurologist due to a previous diagnosis of Multiple Sclerosis. Did this mean because of my MS, I could not be diagnosed with or treated for anything else? i.e. venous disease
Terrifying really since I have a family history of heart disease, stroke, diabetes, and cancer. Will all warning signs of these fatal conditions be dismissed as MS symptoms the rest of my life?
Based on this information I am asking that you reconsider your previous decision and allow coverage. Rescheduled for December 10, 2010 due to our inability to pay such upfront as we had for testing and consultation, time is of the essence.
Please know I will try my best to oblige with anything else required. Do not hesitate to contact me at 812-831-3840 or my husband Jason at 812-760-2683. I pray all presented will suffice in overturning WHP's previous denial.
Angela G. Spindler