appeals

**LaP HaPPy** · February 6, 2007

Hey guys!

Ok, so I mourned my denial for the last month, and I am slowly getting back into the fighting mode. I know I have a battle on my hands bc the denial was due to an exclusion in our policy. My saving grace is UCH told me on 5 different occations I did have coverage! I plan to use this as my "big gun." Wish me luck!

What I was wondering is how many of you won your appeal? Anyone successful after an exclusion? And is there anywhere on this website where you can read the letters other people used to send to the insurance company?

Thanks again,

niki

ReneBean · February 6, 2007

Well

An exclusion is usually placed by your company - they do it to get lower insurance premiums - so you really need to get with your HR dept to figure this out. It may be that they added the exclusion to the policy in January - and you missed getting approved by a few weeks.

Check with HR. See when the exclusion was placed. If it's new - you might be able to fight based on the fact that you started all the pre-op testing prior to the deadline. But don't hold your breath... Really, the only ones who can overcome an exclusion are the ones who pay the premiums...

Good Luck!

cal · February 7, 2007

Hey guys!
Ok, so I mourned my denial for the last month, and I am slowly getting back into the fighting mode. I know I have a battle on my hands bc the denial was due to an exclusion in our policy. My saving grace is UCH told me on 5 different occations I did have coverage! I plan to use this as my "big gun." Wish me luck!

What I was wondering is how many of you won your appeal? Anyone successful after an exclusion? And is there anywhere on this website where you can read the letters other people used to send to the insurance company?

Thanks again,

niki

Hi,

Don't give up hope!!!

my insurance denied me and said they would cover gastric bypass instead....which i didn't want.

i had to get a lawyer to help me fight and the denial was overturned on the phone which my lawyer said was unheard of. i am a Christian and prayed specifically for this to happen

If you have any past surgeries, that will also help.....it helped me!

cal

**LaP HaPPy** · February 7, 2007

Wow, that is great Cal! I think having a lawyer would help, but I am not sure I can afford it right now. I have heard that you get two appeals, and I thought I would try the first one on my own.

**LaP HaPPy** · February 7, 2007

Rene, I talked with the HR and they said that the policy was in place back in July at the renewal. It was actually a UHC error. The last person I talked to at UHC confirmed that there was an error in their computer program, giving their reps false info.

I am having my hubby look into things at work. (He works for the state, so I can only imagine the red tape we will have to work with there)

Heck, I am even thinking about changing jobs so I can go to work for someone who covers the surgery!

Thanks,

niki