2nd Denial From Personal Care PPO any suggestions????

Today my husband recieved his second letter of denial from Personal Care PPO. We have provided all of the additional information from the first denial and this letter states that they the need that exact same information. Documenation of a physician monitored diet. My husband has been on a physical monitored diet since March of this year. In fact I even spoke with a represented and they stated that if we provided the additional information that we would be granted approval. Has anyone else had this problem and if so could you please tell what you had to do to move foward. I believe that if we don't get this resolved immediately that my husband is going to give up. And if he does that I feel that his life could be in jeopardy for all of the health problems that have been linked to his obesity!!!

Is your insurance through an employer? If it is maybe there is a benefits coordinator that can help iron out the problems that you are having. You in the meantime can talk to a supervisor at the insurance company and see why they are now asking for additional things. Maybe the right hand does not know what the left hand is doing. You may also need to get your husband's doctor on board to run interference for you. Maybe s/he can request a peer to peer meeting on the phone to get these issues resolved.

Christine, Thanks so much for your help. I am in the process of talking to my husband's employeer. I have spoke with the insurance company with no avail. One of the problems is that they are now changing what they orginally told us they wanted. My husband has an appointment today with his Family Physician to try and help iron some of the problems out. In the mean time I have filled an appeal and notified the Illinois Department of Professional Regulations Insurance Division. Thanks again. Angel