Appeal process

akonismama
on 5/23/10 4:38 am - Kurtistown, HI
Does anyone know how long it usually takes the medical company to decide on an appeal... Any help would be greatly appreciated. 
(deactivated member)
on 5/23/10 4:52 am - Makawao, HI
Depends on the type of appeal.

Standard - Pre-certification they have up to 30 days
Standard-post-service they have up tp 60 days. 

Not sure the difference.  I am just reading this from my denial letter.

If you do an expedited appeal its within 72 hours. 

Did you file your appeal already?
akonismama
on 5/23/10 3:29 pm - Kurtistown, HI
I am flying from Hilo to Oahu to meet with the bariatric coordinator on June 1, from there we are going to send in an appeal letter from myself , my PCP and also the bariatric surgeon. I hope you dont mind me asking but how long did they take for your appeal? How was your experience with the RNY surgery?  Thank you for all your help.
(deactivated member)
on 5/24/10 11:57 am - Makawao, HI

My situation was a little different. I was already approved but went past my 6 month "approval" period.  I had everything already set to go thinking there would not be a problem with an extension of my initial approval.  So when they denied, I requested an expedited appeal since I had already taken time off from work etc etc.  I wrote a couple of letters and got a decision the next day.  I had my surgery in San Fran with Dr. Cirangle.  The reason the insurance denied was because they wanted me to do the surgery in Oahu.  I had spent 6 months talking with Dr. Cirangle and his staff and did not want to have the surgery with anyone else.

As far as my experience with the surgery.  The surgery was fine.  I have had no complications and have lost 30 pounds so far.  The emotional part of it has been really tuff for me.  I thought I was so mentally prepared for it, but I was wrong.  I went from smoking cigarettes, drinking wine and eating really good food to nothing.  It was and still is a shock to my system. 

Who are you having your surgery with?

(deactivated member)
on 5/24/10 12:03 pm - Makawao, HI
You might want to post on the main forum as well.  There seems to be much more "traffic" there.
akonismama
on 5/24/10 12:55 pm - Kurtistown, HI
Thank you so much MauiGirl for your responses, I am hoping to have my surgery done with Dr. Grief @ Kapiolani Medical Center. I have already written my letter also I have a letter from my PCP and also a psychologist to explain why I would benefit from having the surgery. But I will just have to wait and see what the medical company says... I have many different medical conditions that the surgery could possibly improve but according to HMSA they dont consider it a co-morbity in their policy being that my BMI was 38.1... SOOOO frustrating to know that there could possibly be something that could help me but I get denied because my medical company that I have faithfully paid my premiums for over 10 years, says  I dont qualify because my conditions are not as serious by their policy... I'll keep fighting til they approve it...  Thank you for all your help....
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