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CHA helps Jill fight for a surgery she desperately needed—and won.

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Jill H is a married, stay-at-home mother of two young children. She lives in Lockport, a small town near Buffalo. Jill has experienced jaw and dental problems for most of her life, occasionally seeking treatment when the situation would become unbearable. Jill sustained an injury during one of these surgeries, and was left with migraines, pain, and jaw pain that she thought she would have to live with for the rest of her life.

Her condition has worsened in the last three years, making it difficult to eat solid food. As a result, Jill has lost weight and struggles with dangerously low weight and malnourishment. She has seen many specialists in an attempt to address these issues, including an ear, nose and throat specialist, dentist, maxillofacial surgeon, orthopedic surgeon, and orthodontist. Each of the specialists agreed that Jill needed surgery to correct her jaw alignment, and sent a pre-authorization letter to her insurance provider for the surgery. The surgery was deemed “not medically necessary” and was denied by the insurer. Jill appealed this decision through the insurer, and the appeal was denied. Jill saw CHA’s phone number at the bottom of her denial letter, and decided to call for help.

Her CHA advocate immediately gathered all of the necessary information about her situation and helped her apply for an external appeal through the State. With CHA’s help, the denial was overturned, and Jill was approved for the surgery she needed. Even though she won the appeal, Jill is still working with her CHA advocate as she prepares for the surgery. 

 

“I couldn’t believe she was helping me, advocating for me, for free. I thought, ‘Where’s the catch?’ But there was no catch.” -- Jill