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Kind of nervous about the Level 2 appeal

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I will be mom's autorized agent at the Level 2 appeal this upcoming Tuesday. Although I feel like, I am very knowledgable about her case, illness, and goals, I am afraid I will become irrational or emotional and that will not be good.

Any advice?

It will be me vs. them. They consist of a Dr., 2 RNs, someone from ops, and someone from legal.

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Hi Lori,

I don't have any advice but I know that you will do fine as you more than anyone has been on top of this.

Good luck, I will be thinking of you. I know I said this before but you are amazing. I feel if it wasn't for you, your mom would not be doing as well as she is. You are her guardian angel. :D

Maryanne :wink:

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Just let the words roll forth Lori.... maybe it might help to try to relate to the case objectively... like you were roll playing. That is what I do when I go in for consulations. I sort of objectify myself. I step away for the "me" and look at the situation as if I were part of the medical team. I hope it goes well for you.

Don M

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You've been a great advocate for your mom-- you will present her case better than anyone else could. Could you consult with an attorney prior to going so you know how to win over the legal department? Good luck.

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You will do fine!

It might help to get examples of other cases similar to your mom. You can find cases where peoples prognosis were grim and deemd hopeless, and later it was shown that therapy helped that person to recover or gain strength.

They don't have to be lung cancer cases to make your point. Also, emphasizing how statistics don't apply to everyone and that most statistics don't take into considerations all the factors of an individuals health- they are just outdated generalizations.

You can role-play before the actual appeal. Try to think of possible questions and objections that the other side might have so that you will be ready to answer them.

Lastly, write everything down and have the notes in front of you before you go. It's easier to remain objective and keep on track when you are reading it off of a paper.

Also, a bit of emotion won't hurt your case- it will make your mom appear like a "real" person to them, instead of just a statistic or a name on a piece of paper.

Good luck, I know you will be great!

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Lori...I know you will do a fantastic job of representing your mother in this appeal. You are her strongest advocate and know her situation and her needs better than anyone. Katie gave some great suggestions for you. I like to have notes, just in case I forget. I have found that rather than jotting down everything I want to say, I usually make an outline and then cover each issue. In your case, I would really speak from the heart and let them know how much your mother needs this. I'll be saying prayers and asking God to be there with you.

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See, this is what I mean. Should I speak from the heart and tell them that I feel like the insurance is trying to push her into hospice care when her own Dr. says she is not ready? Or should I be more neutral and continue to find medical journals? I thought I had someone to help me at the Patient Advocate Foundation, but now she won't return my phone calls. She has her degree in therapy and specializes in insurance appeals. I spoke with her last week and everything she told me to obtain I have, but now I need her to help as far as presentation and making sure that I get across the most important points. I guess they are very busy.

I know that it surely would help if mom's neurosurgeon would let me have a copy of the medical journal he keeps referencing "that is about to be published" but he won't. I have already asked. I also asked him for a timeline of hat the epectations are as far as mom's mobility potential, but i have not heard back.

I am seeing a counselor from Cancer Family Care and she wants me to be able to let go of some things. I guess worrying about every detail with the appeal is one of these things I should not be fretting over, but I feel like I have to.

The counseling is NOT helping me by the way. She has met with me, my mom and SF for couples counseling, and all 4 of us and she keeps telling me that I need to set limits with my SF. She thinks that he manipulates me by throwing his tantrums and I give him the results he wants-his way. She also says I do everything which lets him off the hook, but I say if I don't do it, mom will stay in the nursing home. She agrees that our situation is crazy and said she is very worried about me.

Guess I'll just keep truckin on....

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..also Lori, keep calling the person from the Patient Advocate place. Yep, they may be busy but someone will eventually answer the darn phone. Can you go in person?

I think you can speak from your heart and at the same time..throw in some neutral stuff (similar cases) to reinforce what you are saying.

Do you know ANYONE that has ever done this before? It would be so helpful if you did and you could get their input.

I wish you all the luck in the world, Lori


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(Please forgive me if I get too deep here)

When Moses and Jeremiah told God that they were not good speakers, or they were too young for the job, He simply told them that he had chosen them to do this job. Not everyone listened to them, but the point it, they did what they needed to do.

I will pray for you that you are able to do what you need to do. I don't know how it will work out, but you (and your Mom) will know that you are doing the right thing.

I admire you so much!

:) Kelly

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