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    The Griswold Group

    5.0 (1 review)
    Closed 9:00 am - 4:30 pm

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    7 years ago

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    Frank Jude Fuss - My Policy Shop Insurance Agency

    Frank Jude Fuss - My Policy Shop Insurance Agency

    4.4(5 reviews)
    4.3 mi

    It was time for me to sign up for Medicare...yep...that age! My husband and I had tried a variety…read moreof ways to get me set up. There was some mix up with having two email addresses with Social Seurity. With an upcoming birthday, I had to get it straightened out right away and Frank made sure I took the necessary action in time. Finally, Frank got on the phone with them himself and got them to cancel everything so I could start fresh. He signed me up again under one email and then followed up to make sure it all worked. I found him to be helpful and his attention to detail and follow up was very much appreciated. I would highly recommend him!

    I began my life insurance application process with Frank in November 2020. As a new client…read moreprospect, Frank was willing to make multiple phone calls, text messages, and emails per day with me to gather information and details for my application. The process took many months, multiple companies, an in-person paramedical examination, and signing many release forms for the underwriting departments to gather the information necessary. By August, 2021, I received a Denial letter from the company recommended by Frank, based on some medical information from years ago in my medical history. There was a time-sensitive window for amending and correcting the information that was out of context, which my medical provider was willing do, as well as provide extra diagnostics as evidence of good health. But after I received my copy of the letter, I did not hear from Mr. Fuss for weeks, though I expected him to contact me and provide a 'debrief' interview at the very least, maybe perhaps assist in correcting the insurance company's records through the cooperation of my medical provider. But, Frank was no longer available to take phone calls, exchange emails or text messages other than when I finally sent a text asking him to call when he had time available, to which his response referred me to some online 'schedule' I had to now sign up for to speak with him. I was no longer a 'prospect', not money up for grabs, not even worth a 'Thank you for choosing my agency, I'm sorry it didn't work out' sentiment by any form of communication. Now it's the end of September 2021, and I still haven't heard further from Mr. Fuss. Not that it matters at this point, the time sensitive window for amending the denial has closed, and I'm not sure if there are any other companies willing to review my case. I guess I'll try another agent, and hopefully get a better outcome.

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    Frank Jude Fuss - My Policy Shop Insurance Agency - Frank Jude Fuss, Licensed Insurance Agent at My Policy Shop Insurance Agency

    Frank Jude Fuss, Licensed Insurance Agent at My Policy Shop Insurance Agency

    Frank Jude Fuss - My Policy Shop Insurance Agency - Frank Jude Fuss, Licensed Insurance Agent, Health - Medicare - Life - Group

    Frank Jude Fuss, Licensed Insurance Agent, Health - Medicare - Life - Group

    Frank Jude Fuss - My Policy Shop Insurance Agency - Frank Jude Fuss, Licensed Insurance Agent, Health - Medicare - Life - Group

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    Frank Jude Fuss, Licensed Insurance Agent, Health - Medicare - Life - Group

    Priority Health - He would still be alive if Priority Health would have paid for his treatment.

    Priority Health

    1.4(75 reviews)
    3.7 mi

    My agent Barb Chupa at Priority Health, did an excellent job helping me get set up with my…read moreInsurance! Thank you

    Repeatedly deny medically necessary claim, despite multiple doctors indicating the treatment is the…read moretreatment of choice. My mother continues to suffer, for years, after years of appeals by specialists trying to make treatment possible. November 29, 2025 To Whom It May Concern- Since August 2021 our family, most notably my mother, have been dealing with a nightmare in the realm of medical care. The Timeline: My mother began experiencing dizziness and vertigo type symptoms several weeks prior to the August 2021 noted start date. After a runaround seeing different doctors, symptoms were narrowed down to being neurologic rather than inner ear, etc. My mother began seeing a neuro-ophthalmologist (Santos) Oct 5th, 2021. She had an appointment with an audiologist for testing who confirmed that the symptoms were neurologic, namely cerebellar, in origin. Several diagnostic tests were performed, and my mother was found to have very high GAD65 autoantibodies. The origin of these was unknown, and a PET scan was recommended in case this was paraneoplastic. This was denied by insurance, so a contrast CT was performed to look for any tumors that would suggest a cause. No tumors were found. Assuming an autoimmune issue and trying to address symptomatically, corticosteroids, mycophenolate, and plasmapheresis were started. This did lead to some temporary improvement by January 2022. March of 2022 the side effects of the corticosteroids were excessive and the medication had to be tapered and discontinued. New signs of leg cramping were noted. With the decrease in the prednisone, side effects of the mycophenolate increased and this also had to be weaned. By June of 2022, the severe vertigo and frequent vomiting had returned. My mother was referred to the Mayo Clinic, who did not take her insurance, so then was sent to Cleveland Clinic. In November of 2022 she saw Dr Amy Kunchock, an expert in GAD65 diseases and Stiff Person Syndrome. Additional testing including MRI and lumbar puncture were requested, and the condition was confirmed in a virtual appointment Jan 6th 2023 with the Cleveland Clinic. Treatment with IVIG was recommended at this time. We attempted to get this treatment approved, only to be denied. From March 2023 through October 2023 multiple appeals, a review by Maximus (work for Medicare to review denials), a request for hearing with an attorney adjudicator, and subsequent upheld denial by DHHS Judge James Satterwhite transpired. October 17, 2023 Dr Santos sent an additional plea to Priority Health requesting further consideration for IVIG. At that time, it was suggested the cause of denial was that the diagnosis was listed as a GAD antibody disorder, and not specifically Stiff Persons Syndrome. My mother's presentation was also different from the typical SPS patient as her signs began with neurologic symptoms. The request fell on deaf ears. In January of 2024, Dr Santos dug deeper trying to figure out why treatment continued to be denied. At this time, it was found that the insurance required trial treatment with Valium three times daily, and a visit to a movement specialist for additional evaluation. My mother was started on diazepam and had an EEG performed due to unusual new symptoms of a flushing sensation that was found to be seizure-like activity. She also saw the movement neurologist Dr Melanie Taylor on January 22, 2024. At that visit, she was officially diagnosed with SPS. Valium was not helping and was weaned. Dr Taylor put in IVIG treatment request, and moved forward with getting pre-approval. The diazepam trial had failed, the movement specialist had been seen, and we had the official SPS diagnosis. We were fairly confident that all requirements had been met and that we could anticipate IVIG treatment approval. We were wrong. May 20, 2024 the Priority Health treatment denial was upheld by Maximus. For the next several months, we continued weekly plasmapheresis (as we had been since it started in 2021) and managed nausea and dizziness flares as they developed. By May of 2025 (this year) seizure activity had increased. Vision disturbances also were increasing. Since Priority Health seemed determined to never approve the recommended treatments, Dr Santos ordered surgery to address cataracts, then plastic surgery to lift hooded eyelids to try to improve vision and decrease symptoms however possible. IVIG treatment was again submitted for pre-approval. September 15th of this year we got another upholding of denial from Priority Health. Dr Taylor has requested an appeal, and September 16th we got notice that Maximus is reviewing the file again. Priority Health is defending their denial by referencing the Wisconsin Physicians Service Government Health Administrators LCD L34771, Chapter 15, section 50.4.2 of the Medicare Benefit Policy Manual, copied and pasted below. "50.4.2 - Unlabeled Use of Drug (Rev.12860; Issued:10-02-24; Effective:01-09-2

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    Priority Health
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    The Griswold Group - healthinsurance - Updated July 2026

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