Ask MetaFilter questions tagged with appeal

And they say no one should stand between a patient and their doctor

saffry — Mon, 07 Sep 2009 06:51:04 -0800

I need to argue with my insurance company, but my case is such a convoluted mess that I'm not sure how to make my point to them. Help! Long Story: I have Rheumatoid arthritis, diagnosed in 2005. I began taking a weekly medication, Methotrexate at that time. Because my arthritis is very aggressive, I've also taken Enbrel, Humira and now Rituxin, while also taking Methotrexate. The Rituxin is given by IV every 5-6 months. As part of my blood work for the Rituxin in May of 2008, the doctor found that I had dangerously low levels of white blood cells. Although there could have been other cause, he felt there was a risk that I had developed "Methotrexate Toxicity", and took me off that drug. I did I dance of joy, because I hated the foggy feeling the MTX gave me, and was looking forward to being able to drink occasionally without worrying about total liver destruction.

But then...
It was time for my next dose of Rituxin and the insurance company threw a fit. Rituxin was FDA approved with MTX, so they would only approve it for me if I went back on the MTX. My doc, who has a lot of influence with them, having served as a consultant for Auto-immune treatments, was not able to get them to change their guidelines. He put me back on it, at a lower dosage, with another drug to counter the side-effects. I admit that I considered just chucking the MTX as soon as I got it, and pretending that I was taking it. But it does honestly help my arthritis, especially as the Rituxin begins to wear off. So I went back on it last October.

When my next approval for Rituxin was being processed, we hit another snag. They wanted my refill records to prove that I was getting the MTX. But because I'd formerly been taking a higher dose, and had a 3 month script filled right before stopping it, I had a ton of pills at home and didn't need a refill. I dug out all the dates and records and wrote up the reason why I hadn't needed any refills, ending by saying I had enough pills to get me to early June. I even took out all my pills to count, to prove to myself that my math was right. But, it wasn't. There were still about 30 extra pills. I considered dumping them, because I knew if I didn't order a refill in June, they would suspect that I hadn't been taking the Metrotrexate again.

And here's where I'm stupid. I didn't order a refill in June. I was busy, and broke, and used up all the pills I had before ordering a refill in August. My doctor put in for an approval for the Rituxin for this month, and I got the letter on Saturday that I was not approved because I hadn't been taking Methotrexate. Ugh. My doc is on vacation, and he's already argued with them so many times on my behalf, that I hate wasting his time after my stupidity. So I'm going to call them on my own tomorrow to file an appeal an my own.

What can I say? How do I assert that I've been on the MTX like a good little girl, when I can't prove it? It's not like this whole story fits into an easy soundbite. I really need the Rituxin, but the insurance company is not just going to give in and give me a $10,000 treatment because I asked nicely.

Appealing a Property Tax Assessment - need advice in King County WA

Anonymous — Tue, 01 Sep 2009 19:45:20 -0800

Property Tax filter: In August I bought a house in King County WA. The county's assessment of the property is very high. I would like to appeal for a review of the assessment. The desired result is a lower tax bill. I would be grateful for any strategy or advice. Details:
- The house is in the City of Shoreline, WA (north of Seattle).

- The August 2009 sale price of the property was over $200k less than the 2009 assessed value, and $40k less than the 2010 assessed value.

- The bank's appraisal, done prior to sale, estimated the value as just slightly higher than the actual sale price.

- House and yard are in good clean condition.

- The County's "parcel viewer" assessor information database states that the house has 4 bathrooms. Not true. It has 2 full baths, 1 half bath, and 1 water closet without sink. There is also a "roughed in" bathroom without any fixtures.

- The assessor database states that we have half a finished basement. Not really true. The basement has four small rooms. Three rooms are unfinished with concrete floors and no finishing over the wall and ceiling framework. The fourth room has ancient carpeting, a couple sheets of old wood paneling, one wall covered in old wallboard, no finish on the ceiling.

QUESTIONS:

If I understand it right, I can appeal either to the King County Dept of Assessments or to the Board of Equalization . Which one is likely to give me better results?

Apparently I just missed a July 31st deadline for 2010 appeals with the board of equalization. Is there any lee-way for me to get an appeal in, since I didn't own the house until August?

Would it help my appeal to remove the old carpet in the basement and expose the concrete floor? Should I take down the wood paneling?

Is there an easy way to measure the square footage of my house?

Any other tips on get them to re-evaluate in my favor? Is there a way to get it done quickly? TIA.

SSDI claim rejected - help needed.

Tullyogallaghan — Fri, 28 Aug 2009 15:19:07 -0800

A relative's husband has come down with Parkinson's Disease in his early 60's. His application for Social Security Disability Insurance (SSDI) has been rejected and he had his wife are devastated as he is unable to find a job so they were counting on this income. Does anyone know of a free advisory service they could go to who could help them in the appeal process? There are tons of "for profit" agencies and law firms who do this work but, due to their circumstances, a free service would be better. Thanks for any information.

Ummmm...

the NATURAL — Mon, 27 Jul 2009 03:47:00 -0800

MarketingFilter: So. . . I made a tacky (yet delightfully unrefined) t-shirt. How do I best sell it online? [Long jump] A couple months back, I was looking to start up my own t-shirt company, along the lines of established companies UNDRCRWN and Pennant Race -- that is to say, a company with heavy sports influence with a sprinkling of pop culture and a dose of societal commentary. Maybe even a No Mas, but less for hipsters and yuppies and more for hip hop heads and anti-establishment people.

So I came up with a name -- ftw. clothing, with ftw being adapted from gaming-talk as for the win, but with the added connotation of f-ck the world. Our poster boy was going to be Rod "He Hate Me" Smart, a one-time kick returner for the Panthers (and other lesser stints).

My flagship shirt? In the spirit of old NBA playoff shirts featuring starting fives, I would have a simple black-on-white colorway and a starting five. But my starting five wasn't going to be a basketball team -- it was going to be related to crack. (Here's where the collective "eep!" comes in.)

Now, you might ask, but why? That's horribly tacky, maybe even not delightfully unrefined, and probably very offensive. And yes, I acknowledge that. It's kind of the point. I wanted a "statement" shirt, one that would make people think -- because really, for middle and upper America, and especially in my home of Hawai'i, crack is something that people think of in abstractions, and ghetto is a term applied to anything sketchy, when really, some of the worst ghettos are terrible things. I wanted a shirt that would put this reality in peoples' faces. In a way, it was like the infamous "Snowman" shirts popular earlier in the decade.

The shirts read:
Pyrex &
The Arm &
The Hammer &
The Spot &
The Raw

I printed them hoping that I'd be able to sell them (via consignment or whatever) in one of the newer less-established boutiques in Honolulu. I approached the one that I thought would give me the best chance, and the manager was totally cool with me -- but because of limited space, he couldn't run the shirt on the store's shelves. But if I showed him a season's lineup of designs, he'd be willing to put me in touch with his industry contacts and maybe I'd get something serious rolling.

After tinkering around and coming up with some designs (some were even pretty good) I realized that I didn't have enough to make a season's worth, probably because it was never my intention to make this my entire career. The manager understood, and encouraged me to give it some more thought and maybe talk to him in the future if I wanted to give it another run.

But now, I have 13 shirts left (I printed 15, thinking that I would get them on shelves, no problem) and I don't really know how to market them online.

They're not made with enough love for etsy, I can't get into supermarket, and I think that on other lesser sites, they'd sell... but probably over an extended period. eBay is a possible strategy, but I'm unsure about how to market them/title them and if they'll sell (and auction fees are preferably avoidable).

So... how do I move these shirts, preferably quickly, preferably digitally? (But any kind of movement is fine!)

(PS. For those of you who sometimes like to dig in OP's past records for dirt/help/what have you, yes, I acknowledged I set off a real sh!tstorm [that I'm just now reading, hey!] with my very first AskMeFi. The lesson, as always: sometimes I'm a real idiot. Sorry if you remember it, and doubly so for the ignorance.)

Thanks.

How to appeal termination of COBRA benefits?

Macbeth123 — Sun, 05 Apr 2009 22:43:21 -0800

The company that administers my COBRA benefits terminated me because, they said, of an NSF check, which my bank had told me would clear. But it didn't because the check was put thru literally hours before a hold on a $500 check was released. Apparently the bank rep was figuring that either A) the bank would pay the check (they have before) or B) the hold release would happen before the check came thru. My cyber-statement even shows that the check was paid; then the next day it was sent back. (So when I checked my cyber-statement to confirm the info from the phone rep, the check was shown as having been pd.) Q 1) How and to whom do I appeal? Q 2) Is it worth the effort?

Parking ticket appeal denied. Now what?

deadcrow — Sat, 14 Mar 2009 08:43:28 -0800

Is there any hope for getting out of a parking ticket that was wrongfully issued (after they denied our appeal)? (forgive me if this has been asked before, a quick search didn't help me answer my question)

Last weekend my husband and I took a 12 hour (round trip) drive to Folly Beach in South Carolina. We found a parking spot (labeled #1) right on the beach and adding money to the drop box every couple of hours to make sure we were parked legally. We got a ticket which states that we were in spot #2. We were not, but didn't take any photos because we didn't notice the discrepancy until we were on the way home. We filed an appeal online.

It was rejected with this tidbit: We are sorry but Our records show that you were in spot two not one.There was no money in space two. Were sorry but your appeal has been denied please pay 20.00 by 3/21/09 to avoid any further charges.

There is no clear process for another appeal. There is a phone number on the city website, but of course, they emailed the denial on a Saturday, so we can't call back yet.
Is there any way we will not have to pay this ticket that we 100% did not deserve? Any suggestions for increasing our chances for success?

How do I appeal a college decision in my situation?

jellywerker — Fri, 16 Jan 2009 12:38:30 -0800

[college application denial stuff] What do I do now? I was denied at the university of my choice, the only one I applied to due to the attitude of the crew coach and admissions officers. Even though I gave my verbal to the crew coach, I was denied. I contacted my admissions counselor at the school and found that two English classes I failed several years ago are what held me back. These were taken through a program at my high school that lets you take community college classes while enrolled in high school. I graduated last year (2007-2008 school year) with a ~3.3 gpa (though it's complicated to calculate due to my homeschooling, my hs transcript shows a 2.8 but doesn't show the letter grades of the high school classes I took when homeschooled. Adding these in and recalculating the total gives a 3.3), dropped from a ~3.8 due to those classes as well as an 1800 SAT. Despite the advice of my counselors I took the classes online and attribute part of my reason for failing them to that. I am perfectly capable of doing well in college, I know that, but I don't know how to explain that to the people who can make decisions in a way that will help them reverse their decision. Failing those classes made me realize how important my education actually is to me. While I graduated in June 08, I stopped doing anything scholastic after the first semester of that school year because I had all the credits I needed and started working part time. I recently retook the SAT and scored 200 points better than previously, and applied to school this year for fall 2009 admission with this new score. I just received my letter yesterday telling me of my denial. I wanted to retake the classes I had failed either last fall or last summer but due to NCAA regulations was advised against it by the university's rowing coach as well as my high school coaches. I only applied to this one school because the opinion of the admissions counselors was that I should make it in just fine, and the crew coach said I didn't need to worry about it.

Well I am worried about it now. I plan to appeal, but like I said I don't know what to say or how to say it in a way that won't come off as asking for pity or something, and of course I won't know anything until April. I want to let them know I am capable, but unable to actually do anything academic to show it until I know what's happening as far as college athletics go. I feel let down by the coach and the admissions officer, especially when I see some of my friends get in who are not close academically, and on equal footing athletically and extracurricularly. In short, those classes are a fluke and I need to convey that.

I have been talking to my brother and working to develop some alternative plans such as late application schools and transfers, but I don't want to do any half-assed schooling. I'd also like to talk to my parents, but my dad has already given me an ultimatum that if I don't get into school this year, he expects me to join the military, so I am afraid to tell him until I have a plan for getting to school.

List of Medicare rates?

twiggy32 — Sun, 14 Dec 2008 11:01:54 -0800

Where do I get a list of Medicare payment rates for surgical procedures? I am currently involved in an insurance appeal over a robotic excision of a tumor in my pelvis. My insurance company only wants to pay a small fraction of the cost of the surgery, saying that since I was out of network, they only have to pay Medicare rates for the surgery. It would be helpful in my appeal if I could find a list of Medicare rates for various surgeries, and see if Medicare even has rates for robotic excision. Can anyone point me in the direction of a list of rates? Google hasn't provided any results that tell me what I need to know.

How can I get websense to undo a nonsensical "sex" block on my boring blog?

cortex — Tue, 23 Sep 2008 10:37:18 -0800

Websense has apparently blacklisted my personal blog (my whole domain, in fact) for adult/sex content, which is pretty strange. What can I do about this? My blog is geeky and banal. The only thing I can think of that'd even be in the neighborhood of "adult" content is a short chapter of a several-years-old NaNoWriMo novel I was posting in real-time, which featured among other things some not-very-sexy sex between two characters.

But that has been on the site since 2005, and I only started getting anecdotal reports of websense trouble in maybe the last year or so. Which has me all the more boggled.

Is there any way to find out what triggered the listing, when, why, or by what mechanism? Any channel for appealing this with the company? Anybody know a guy who knows a guy?

An Appeal for an Appeals Lawyer

Shane — Thu, 17 Jul 2008 11:16:37 -0800

How to find an appeals lawyer who will want to take a (probable win) appeal to the US Supreme Court? Like, do they, um, hang out on the 'Net somewhere? A friend of mine is the defendant in a CT State civil suit she is appealing to the US Supreme Court. The law under which she was prosecuted is extremely vaguely-worded and tends to trample on basic constitutional rights. So far this law has been used only twice, in each case to "smack down" people who have ticked off the State of CT. Lawyers, not just my friend and my (biased) self, agree on these points.

How can she find a good lawyer willing to take the appeal on a limited budget, hopefully for the chance of an impressive win in the Supreme Court? Or is that really something lawyers want? Maybe someone young and hungry? Countersuits would naturally follow a successful appeal, should the lawyer be interested.

She could also use legal counsel on a budget, of course.

Thanks, folks.

ImmigrationFilter: Can I stay to appeal?

sweetlyvicious — Thu, 10 Jan 2008 20:15:42 -0800

ImmigrationFilter: Can I stay to appeal? I've just come home to find a letter from USCIS with a notice of the decision to deny our family's Permanent Residency application. Not only that - according to the notice as of the date of the decision, my employment authorisation is revoked as well. I can, however, appeal the decision within 30 days.

Understandably, I'm freaked since I have no access to the immigration lawyer or my company's lawyers until the morning. Can anyone answer whether I may stay in the US during the appeal process? Or at least stay the 30 days I have to file the appeal? Do I have to leave right away?

Thanks!

Help me block my neighbor's panopticon.

ikahime — Fri, 26 Oct 2007 22:00:53 -0800

New to dealing with district court of appeals... Recently, we failed in blocking a neighbor's variance request to build something that will adversely affect our property. Now must file appeal with district court. I feel like this is something we should be able to do on our own, but I can't find any helpful guides around, and I can't really afford to seek legal advice. I only have 30 days - any advice?

The Dillon Brothers: A Study in Hotness

Hat Maui — Fri, 16 Jun 2006 03:49:11 -0800

why is matt dillon so much better looking than kevin dillon? look, for some people this contention may be up for debate. for thoe rest of us, however, it's clear matt dillon is way better looking than kevin dillon. how come? they both have good physiques, facial symmetry, and the same genetic stock. so what is it about matt that's way sexier?

How to deal with college red tape?

Anonymous — Thu, 05 May 2005 09:57:25 -0800

I have a disgruntled professor whose only goal seems to burn every bridge in his path. Assignments that were turned suddenly aren't there, grades are arbitrarily assigned for no reason. The administration knows of this and appears to be willing to work with students but tells us we have to wait until the end of the semester for a grade appeal process... Basically this is the typical teacher horror story that I don't feel like going into detail here. I have the dates all down, I've contacted my advisor, the dean, everyone between here and my school. Other very good students are also experiencing the same grief and have contacted the administration. The teacher has been canned (for reasons I don't believe relate to this) and seems to be taking it out on everyone at this point. While everyone in the administration has acknowledged that what he's doing is wrong and says they are willing to help us... they say we must wait until grades are given and go through a grade appeal process. This is an introductory course and my lowest grade so far in the college process has been one B. I only have two semesters left to go. If I receive the grade I'm told I have in this class, I will lose all my scholarships for the final year and this will look very odd on any transcript, along with significantly lowering my total GPA. While I would love to trust the administration on this one, I always get uneasy feelings when they can't promise outright our grades will be changed (which to an extent is understandable). Does anyone else have experience with something like this? Should I rest assure that the administration will really help us, or will this be a long battle of red tape and paperwork? I'd absolutely hate to take this class over again, meaning I'd have to enroll another semester -- but I'm more worried about scholarships at this point. The adminstration keeps telling all of us to simply wait until the year is over and then they will help us. Is there anything I should be doing to protect myself further? I'm documenting everything and I think anyone who has half a brain would see this looks very odd -- academia scares me with their slow pace and protection of their own. I could be just simply paranoid but I'm a big non-complainer and have no experience in something like this. I should emphasize that the administration has been very, very understanding of what has been going on and does not dispute anything that's happening, they just are telling us that there hands are tied until grades are issued and they don't wish to further anger the teacher through confrontation. Thanks!