Recently Jerry, my husband, was diagnosed with a medical disorder.  His
physician at the U of M gave him a number of alternatives for treatment. 
Jerry chose the least intrusive (and least expensive) method to try as a first
step.  We think the treatment has been effective but further testing will be
necessary to determine if this is so.  The problem is, our PPO (Blue Cross
PPO) has rejected payment for the treatment.  Jerry's MD wrote a wonderful
(we thought) letter to them explaining that Jerry's choice was far less
expensive then surgery or other options.  They still rejected payment.
They say, "the therapy you have chosen is not a payable benefit under the
terms of our Blue Cross Blue Shield of Michigan contract."  They do not
provide any further information other then to tell us we can file an appeal.

Can anyone give advice on what we could say in an appeal or how we would best
go about this?  I would provide further information to anyone who could/would
be helpful through e-mail.

7 responses total.

First of all - definitely appeal. We had a rejection in the case of our
daughter who had a hives attack while at Y camp. It was an emergency, so
there could be no prior appeal. We made outselves out to be people that
would not only appeal, but be a nuisance ( 8^} ) . I think they saw that
the lesser of two evils was to pay up. 

Ask for the procedures for filing an appeal. Do you know a lawyer who
would file the appeal on your behalf, inexpensively? That would get them
to thinking....

Also, put your information together in a (detailed) summary and request the
appeals process _in writing_, with return reciept.  You might want to send
a copy of this to the Insurance Commissioner in Lansing (used to be part ot
the Atty Generals Ofc, but now it's in Commerce, I think).  Consider sending
copies to your federal reps and senators as well.  And be sure to put those
cc:'s on the letter that goes to BCBSM.  They'll probably pay.

This is a perfect example of "managed-care" (or better, MISmanaged-care). 
It is why, after several recent years of a booming growth in managed care
plans nation-wide there are now movements afoot to regulate them (ie; the
patients bill of rights, on the national level).  Michigan governor may not
be on your side in this, there are partisan issues related.

In effect, what the managed care companies claim is that you exercised your
free choice in health care when you signed with them for lower premiums for
"better" coverage.  Let the buyer beware...if it looks too good to be
true...it probably is.

can any body advice, what is a good food for diabetes person
help

Anything that takes a long time to digest, for instance high fiber fruits and
vegetables.  Not grapes.  Beans are good (lentils, chickpeas - garbanzos),
I think you call them dal.  Rice is good, I think.  Mta knows more.
Is there a separate discussion item about diabetes?  You should eat
frequently.

keesan, many diabetics are being steered away from high carbohydrate foods,
which cause a high insulin response in the body.  If a person has been
diagnoesed with diabetes, they are usually given an eating plan by their
physician.  The biochemistry of diabetes is much better understood due to
research advances in the last 5 years.  Given that research, I wouldn't put
any of the things you suggesting into my body if I were diabetic.  

What would you suggest instead?  I have read that high fiber foods put sugar
into the blood stream more slowly.  That fat is bad for diabetics.

I'm late to this thread but will contribute what I know.  This
might go on for a few lines so beware.

The body sees all food as either carbohydrate, fat or protein, or a
combination thereof.  Carbohydrates are readily converted to sugars which
course through the bloodstream and, with the help of insulin, are
available to cells to fuel metabolic functions.  Some (but not a lot) of
the protein breaks down into sugar. Fats aren't converted into sugar. 
Diabetics have a problem when there is either insufficient insulin
production to allow cells to get the sugar or the cells have become
insulin resistant.  Either way, blood glucose levels are elevated and
cells are essentially starving.  (This is an oversimplification but
tends to hit the important points.) 

The whole idea behind a diabetic diet is to make sure a person has a
well-balanced diet, rich in the same nutrients we all need, with a
carbohydrate load that is evenly spread throughout the day.  In the old
days there was a distinction made between simple and complex sugars but
they now know the body doesn't use them any differently.  In terms of
blood sugar levels, grapes or a potato or chocolate all look the same
carbohydrate gram per carbohydrate gram.  Fiber makes a small difference
but it's more the amount of carbohydrate that's consumed at one time than
whether you eat that chocolate with a Metamucil chaser.

Too, in the old days low carbohydrate and higher protein plans were the
diet of choice.  Not so any longer.  A high protein diet tended to be hard
on the kidneys (ketoacidosis) and diabetics are prone to kidney disease. 
The new diabetic diet now looks very much like the food pyramid diet most
everyone is encouraged to follow, with somewhere between 50 and 60 percent
of the day's calories spent on carbohydrates.  Again, evenly spread
throughout the day, in at least 3 meals and two snacks.

There are no forbidden foods but there are better and worse choices.  If
you can have 22 grams of carbohydrate at each meal and you choose to have
chocolate with that fish then you're going to get a very small piece of
chocolate with minimal vitamins and minerals for your calories. You'll
feel more satisfied and get more for your carb grams if you choose whole
wheat pasta or brown rice or lots of broccoli.  But either way your blood
sugar will be the same as long as the portions are appropriate.

Diabetics, well controlled diabetics, tend to think of carbohydrate-rich
food as they do drugs, the right dose at the right time.  But nothing
is forbidden.

Anyone newly diagnosed as diabetic must see a registered dietician
for information and a personal plan.  If you're doctor didn't
set you up with a referral you need a better doctor.

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