Appeal with a attorney

[Jessiegurl2686 104]

Has anyone here used a attorneys office to appeal a denial from insurance company!??? If so why were you denied and also how did the appeal turn out for you?

[DanaMomto3 145]

Did you appeal to your insurance company? Do you have the 2 co-morbities?

[Jessiegurl2686 104]

I haven't appealed ..... My dr office said to go through a attorney they have used . My BMi is 35.9 ...and have one cormorbite. I have everything I need. I've been dealing with this since June and was denied last month because I didn't have 6 month diet and wasn't enrolled into biriatric program. I have all that taken care of now expect now they un registered me because I only have one cormorbite

[iggychic 1,405]

IF the rule is two comorbidities, basically you're just throwing your money away hun.

[heartonmysleevey 133]

Hi! Hope this helps. I don't know what state you live in but, I live in CA and of insurance keeps denying, you can file a grievance against your health plan through the department of managed health. I think even an attorney will tell you to file a grievance through your insurance provider first. Best of luck to you!! XXX

[Jessiegurl2686 104]

IF the rule is two comorbidities' date=' basically you're just throwing your money away hun.[/quote']

The attorneys office stated something like insurance company's can have whatever rules or guidelines they want but it comes down to the health commission . Which states if u have a BMi greater than 35 with A cormorbite that is enough to get surgrey .dunno if it's called the health commission .

[JennyBeth 127]

Every insurance company is different and can make whatever qualifications they want to cover the procedure. I have never heard of someone needing to resort to using an attorney to appeal. Honestly I would take the money you would spend on an attorney and just pay out of pocket for the procedure. You're probably going to spend just as much on an attorney and you still have no guarantee that your insurance will cover it.

[Jessiegurl2686 104]

It's 600 to have them appeal it. My surgeons office has been using them for years and have had pretty good outcome . I've done everything eles I'm supposed to do..... I'm just giving up.

[tinarho 29]

switch insurance..i have preferred one, they have no waiting period and only 1 comorbity. i started in late october and had surgery dec. 31. good luck!

[JennCH 19]

Insurance companies do whatever they can to not pay. I do insurance reviews (cancer - not WLS) and 80% of the time I approve the appeal unless there is something VERY specific in the policy that I can't figure out a way around.

[Jessiegurl2686 104]

According to UHC's website, you qualify: (updated 12/1/2013) Bariatric surgery, as a primary treatment for weight loss is proven for the following: 1. Class III obesity (BMI > 40 kg/m2) 2. Class II obesity (BMI 35-39.9 kg/m2) in the presence of one or more of the following co- morbidities:  Type 2 diabetes  Cardiovascular disease (e.g., stroke, myocardial infarction, stable or unstable angina pectoris, hypertension or coronary artery bypass)  Life-threatening cardiopulmonary problems (e.g., severe sleep apnea, Pickwickian syndrome, obesity-related cardiomyopathy) https://www.unitedhe...ric_Surgery.pdf

[iggychic 1,405]

The attorneys office stated something like insurance company's can have whatever rules or guidelines they want but it comes down to the health commission . Which states if u have a BMi greater than 35 with A cormorbite that is enough to get surgrey .dunno if it's called the health commission .

I've counseled people on here many times about insurance and my answer was quick because I was in an airport so let me expand. There are state and federal laws that superseded insurance company policies on occasion. If your state has a requirement of just one, the insurance co must approve...but that should be pointed to your employer first as they will want to fix that Best of luck