Insurance Denied..now what?

Hello all!! Well I heard from CTcare today that they denied my surgery..something about exclusion..I called them 2 times before I went through the process and they said they do cover it. I left a msg for Lois today but she didnt call back. I go to see the dr tomorrow for a biopsy on my thyroid nodule tomorrow so i will talk to Lois then. I was just wondering if anyone knows the next step? What a nightmare. And in the beginning I said if something stopped me along the way, then I would not proceed with the surgery, but I do think this is just a formatility and hopefully I will get approval before Dec when my insurance no longer covers it completley...sorry to vent..been a stressful day - grams not doing good again and they are basically telling us to say goodbye...what a great way to start my new year! Shana tova!! thanks!

Hey Dawn, Don't even think about giving up!!! You stick to your guns and Fight!Fight! Fight! you have come this far don't turn your back on the Surgery. I am in the same boat as you with Connecticare and this is what I am doing Email the Insurance Commissioner, Attorney General. Did they notify you in writing stating that they will not cover the Gastric Bypass before your policy renewed? I just learned that if they didn't there is a fine for this. And the insurance comissioner is working with people that had all there Gastric BYpass preops done and when surgery came around they were told the insurance wouldn't cover it. Those *******s!!! Let me know how you make out. Keep your chin up! Hydie L

Dear Dawn, Peter's absolutely right - get started on the appeal process at once, and enlist the help of your HR/benefits manager. Dr. A's office may even be able to provide some direction as you pursue this, although others would be better informed about that than I. The exclusion clause must come as a shock as you had looked into everything ahead of time... I remember talking about it with you. So sorry to hear Grammy is not doing so well; you are both in my thoughts at this difficult time. Fondest thoughts and hugs, from Mary M

If all else fails you can contact Gary Viscio (an attorny) to compose your appeals. He only deals with these types of matters. Check out my profile for his website. I don't know it off hand. Good luck and don't give up Vickie

DAWN DONT GIVE UP !!!!!! DONT LET THEM GET YOU DOWN !!!! FIGHT FIGHT FIGHT FIGHT!!!! THIS IS YOUR LIFE, DONT LET THEM DENY YOU.....I DIDNT HAVE A PROBLEM WITH CTcare AND I GOT APPROVED A WEEK BEFORE MY COMPANY CHANGE INSURANCES....I WILL KEEP YOU IN MY PRAYERS THAT YOU GET THIS SURGERY......CALL AND WRITE TO WHOMEVER YOU HAVE TO...... ANNETTE

Sorry to hear that the battle is not over. Did you get names of the people you talked to when you checked before?? It goes a long way. The insurance company does NOT have to inform you of changes. It does have to inform your benefits manager and they should keep you informed, but there is no legal requirement unless you were already approved for the procedure and they then cancelled the procedure. Check with them when the exclusion started. See if you were "in progress" during the changes. Important to the insurance commissioner. Start your appeal process immediatly. Don't wait. Time is on their side, not yours. If denied, file an appeal to the insurance commissioner immediatly. Peter

Thanks all for your suggestions...I did find out that its my employers exclusion, not CT Cares...even though at least 4 people i know of in my company had the surgery (one as soon as 4 months ago!) and my employer said it was an exclusion since 2002. how crazy is that! I am waiting for the denial letter to fax over to Dr As and hopefully it will help out. i feel so stressed...but everything happens for a reason so i assume its just not my week to have surgery!! thanks again