Down & Out...

That sort of happened to my DH with Cigna. They approved him, saying that the surgery was medically necessary, then they came back and said that because he did not have 6 months of a medically supervised diet with his PCP therefore they did not approve him. He did have 1 year plus with a doctor he goes to (he could not stand his PCP and paid for his med care out of his own pocket) that were unsuccessful to loose weight. Cigna is tough to get approved with, I know that they are not your insurance, but some of the other insurance companies are just as much of jerks with the approval process. My DH was covered under my insurance with BCBS PPO of IL.

I know EXACTLY what you are feeling. I am in the same boat. BUT, exclusion or no exclusion you have the right to appeal. reply and type out the exclusion. Then tell me if you have a self fund, or self insured plan. Is there a rider explaining why the exclusion is excluded. Right in the middle of my appeal, same thing, except I still know I can appeal. My appeal is going to be done in a different way though this time, because I am convinced these insurance companies do not look at your records thoroughly. Don't give up, they want you to fight and they think you are going to throw in the towel. Don't. Barb

Shelley, I am sorry to hear about this set back for you. I have come to believe that having insurance is great as long as you don't need to make a claim. I promise to keep your situation in my prayers. Keep a smile on your face and your head up! Your dong the right thing by rambling here! Dan