denied again

erikafroling · November 22, 2003

Well it happened I was denied again..To start over ...I went to a Dr.Grossbard in tampa fl, and he told me i had a few comorbids and would have no problem getting approved ..i have UHC..so about 2 weeks later the ins. girl called and said they denied stating not medically necessary and she was resummiting with plenty of reasons for a approval..well she called me about 2 weeks after that and said im so sorry they denied us again and suggest i write a appeal letter.. I am so fustrated and sad and well alot of you know what i mean...The worst part is I am waiting to get a back surgury I am 225 and 5'5 and the back surgen doesnot what to do a surgury untill i lose the weight and the pain is so bad im having trouble walking,bending,sitting, just about everything.. I dont know how much longer i can take the pain ..ive been following the adkins diet while i was waiting for the band surgury per my dr..stating it shrinks the liver..and im so depressed..so where do i go from here? my husband is not keen on the mexico thing.so I dont know what else to do ...HELP ME PLEASE

Brandi · November 22, 2003

I would definately write an appeal letter....and another.....and another, until they finally give in. I have heard of other people having this same problem and not giving up until the insurance company gives in. Maybe someone at your doctors office could help you out with the appeal letter and tell you exactly what to include. I HATE insurance companies!!!!!!!!!!!!! I can't imagine how you are feeling now, especially since your doctor told you it shouldn't be a problem. But hang in there and don't give up.

Brandi · November 22, 2003

I forgot to mention....maybe you could have your back surgeon write a letter stating that it's medically necessary. Maybe if they have more than one doctor telling them, they'll approve it. Just a thought.

seanmama · November 22, 2003

Another thing- go and get a copy of the letter/s that the surgeon's office wrote to UHC. Note what details were and were not in the letters. Carefully read the denial letters from UHC. Try to determine exactly why you are being denied. Then address this in your appeal.

It is better to take ownership here! CONVINCE them that you MUST have this procedure. The lady at the drs office is just doing her job- she does not have the conviction that you have.

Good luck.

erikafroling · November 23, 2003

thanks for writing..i did have 4 dr's notes stating need for the surgury. also the denial states my insurence doesnot cover any weightloss procedures no matter what medical requirements are met. did any of yall get ideas for letters on the internet and were can i find them.thanks for all your help