Insurance appeals???

dovie6523 · December 27, 2005

Hello there! This is my first post. I am disappointed this morning, learning that my insurance has denied my coverage. However, First Health is requesting more information from my doctor. Has anyone else had this trouble and what tips can you give me that may help the process along?

:confused:Thanks in advance.

nanahanna · December 27, 2005

Hi Dovie, I just got through reading the sticky at the top of the page titled "Just starting to explore options...help!!!" and it had lots of good info on appeals etc. with some copies of suggestions of how to write appeal letters. Check it out. I haven't even tried to get my insurance to pay yet as they say expressly they do not cover weight loss surgery or meds....but I may go that route and try to get them to pay. Good luck!

Nanahanna

December 27, 2005

Hi Dovie,

I was told that 90% of insurance companies will deny at first try ...so then the appeal process. Don't get discouraged. Bekah

ReneBean · December 27, 2005

The First Step is to read your denial letter. They should specify what your options are for appealling the denial.

Then, you have to decide whether you want to engage an attorney to help you. Definitely read thru the sticky thread and any other threads in the insurance section. Several attorney e-mail addresses are posted in among the information.

I had to re-submit to Blue Cross before the State of California would look at my request for Independent Medical Review. I am waiting for the State to do their thing.

I would definitely appeal - whether you use an attorney or not. It costs nothing but time - and there is lots of info in the insurance forum to help.

And NanaHanna - all policies exclude weight loss treatments - but many of them have an exception for Morbid Obesity. BMI over 40 = Morbid Obesity. It's an ugly word - but if it get's your insurance to cover banding - wave it like a flag.

Good Luck!

nanahanna · December 27, 2005

Thanks Rene. I am thinking about doing a precertification to see what they say. I have to get my husband behind me on this though. He has rolled his eyes at me whenever I have mentioned any weight loss surgery before. He thinks I can do it on my own even though I havent been able to do it! If I can get some help paying for it...I am definitely doing it!

Nanahanna

Alexandra · December 27, 2005

Dovie, requesting more information is not the same thing as denying coverage. All that's happened is that the carrier is seeking more information to make their decision. That's actually a very good sign, because it means they're looking at the merits of your request rather than denying you outright for some blanket reason (such as an exclusion).

Don't worry! This is by no means the end of the road. Good luck!!

dovie6523 · January 3, 2006

Thanks for all you support!!! I am trying to patient and tenacious! I will let you all know how it goes. Thanks again. It is a relief to know that I am not the only one out there.