Denied... I HATE insurance.

fatnurse · September 27, 2007

I was denied approx. 2 weeks ago. I have EBMS (employee benefit managment services) I am now trying to get more convicing letters of support from my PCP (shes dragging her feet) but I did receive one from my OBGYN (for PCOS) and will get one on Monday from my electrophyisologist (specialized cardiologist, for my tachycardia)

What did you do after a denial? Here is a list of my diseases : PCOS, (causes very low insulin resistance), tachycardia, acid reflux, infertility, sometimesy high blood pressure, depression/anxiety. I"m 5'1 and 220.

What do ya'll think? Please let me know of any tips you may have.

Thanks Alot...

Oh, i'm new to this so excuse me if I mess anything up.

Cherylbo · October 4, 2007

Sorry.... I hate insurance also! I was just denied by my carrier as well. The company I work for elected to have a bariatric exclusion on the policy to save money. What's really ironic is that I work for a large insurance broker that offers coverage to physicans who do bariatrics. I was so excited to have this surgery....think I'll go eat a twinkie....

Hungergames · October 4, 2007

My company also excludes this surgery. We were acquired by another company 3 months ago who swore up and down that our coverage would be as good or better than our existing coverage (where this procedure was covered). Of course, everytime I call UHC I get a completely different answer, so who really knows!! UGHHH...............:faint:

fatnurse · October 4, 2007

I'm sorry to hear that, but LOL on the Twinkie business. Are you going to appeal the denial? I recieved the last letter of support from my ONE of my cardiac doctors, so I typed my letter and had my mom also speak on my behalf due to a strong family history of cardiac problems. I hope to get reweighed and send all this stuff in my Tuesday or Wednesday of next week.

Please keep me updated on you situation. GOOD LUCK:biggrin1:

Cherylbo · October 4, 2007

Good luck to you also!

Isn't it ironic that the insurance companies will shell out the money for a heart attack and all the other complications of weight but not something to prevent the problem in the first place?

faithmd · October 5, 2007

WHY were you denied? If it was becuase of a total exclusion then you have little to no recourse. If it was based on other factors, do they not have to tell you exactly why so you can fix it? I was denied on the first go-round as well, but it was because I hadn't lost the 5% required by my company.

fatnurse · October 5, 2007

Isn't it ironic that the insurance companies will shell out the money for a heart attack and all the other complications of weight but not something to prevent the problem in the first place?

I know... isn't it. That was one of my main points in my appeal letter. I really hope they listen to me. I have already consulted a lawyer for backup but I hope it doesn't go that far.

If it was becuase of a total exclusion then you have little to no recourse

I really have NO idea what that means... total exclusion. Um, they told me I was denied due to an outside source "their medical team" didn't think it was medically necessary. Yet, that was before I picked up 2 cardiac specialist and had an EP study and all that jazz. So now I have more letters of support and hopefully a compelling letter.

Have a great night! Hope to hear from ya'll soon. :notagree

rtgirl77 · October 5, 2007

I think what she meant was that if your policy has a total exclusion, i.e. they don't cover ANY weight loss surgery for any reason, then there would be nothing you could do about it. But, it sounds like your policy allows for it in cases of medical neccessity so you are probably on the right road by getting more evidence that it is medically neccessary.