Denied

Okay..I am totally bummed...My insurance denied me today!! The surgery is a policy exclusion...My surgeon's office stated that I need to submit an appeal letter...but right now, it just seems so overwhelming..I don't know where to start..Has anyone else been denied for the same reason?? I don't know what to put in the letter or anything..Ughhhh!!! I am just soooo upset now and I really want this..anyhow...Thanks for listening..Please let me know of any good suggestions...I have Vista HMO..~ Tricia

Hey Tricia, I am so sorry, but don't give up that is what they want you to do. You have to be strong. When I had to appeal I called the insurance agent and they helped me with the process. You obviously did not know it was an exclusion before. Sometimes companies do that to lower the premiums. If my appeal did not work I was going to take legal action. If you need to go that route, let me know and I will find out for you who to contact. Keep on Smiling!!!!!! Christine

Patricia, if WLS is a policy exclusion, you are going to have a hard fight. You may want to get an attorney to help. Good luck. Steve

dang... i am sorry to hear that.. dont give up...

i would have to agree with steve, if the policy excludes this procedure specifically then it is probably not going to be appealable. the only thing i could recommend is changing plans.

A lot of times HMO's have the exclusion. However you must prove necessity. Which of course I see that you did. They want you to have at least 1 year diet history. Which I think you started one in June 2004. Next are the co's. What problems has obesity caused? I would appeal. Even though there is an exclusion. Don't accept No for an answer. Remove that word from your mind. Appeal Appeal Appeal. Did your insurance pay for all of the testing? Think about it..... When all else fails read my profile then go to Vocational Rehab....... Best of luck.

hi, sorry to hear about your denial. Here's a couple of profiles to read......sharon neva and sharon brittain, they have alot of great info in them, hope this helps and good luck on your appeal. tammy

Hello, so sorry to hear you were denied. There are several excellent atty's online to help with the appeal. One has had the surgery, so he knows where we are coming from. You will need to do a bit of research on internet. Unless some one out there knows their names. Marla