Tired of being denied:Read on

After trying to argue the exclusion in my Group Health plan with the T.P.A. of the self funded plan, I knew I needed a liason. For some reason, I called the Illinois Lt. Governors office today. Spoke to a wonderful person in the Constituent Services Dept. The lt. Gov is Pat Quinn in case you don't know. Well a miracle happened. Unbeknown to me in Jan of 2005 a law was passed in Illinois (only 11 states) where anyone is entitled to an external review, and may appeal their case through the Lt. Governors office. Within hours, my Surgeons records of medical necessity and Dr. reports indicating a need for this surgery to better my health was faxed to the Claims Administrator (insurance). I was told that my claim my be decided on without the language of the plan. In other words, using some common sense. I don't know if this is going to help me or what. Because I have been so persistent and arguementive with the insurance, still they never bothered to even do a real internal, or independent review, they saw the exclusion and said no, no, no, no........ If anyone is in this situation and you have tried everything, and you have tried every avenue to get approval, then this should be a last resort. The Lt. Governors office told me they have had a great deal of success in their particular office. If interested go to Lt. Governor Pat Quinn home page, go to the Constituent Services link. Please everyon say a prayer to St. Jude for me, that this shakes up the insurance a little. I am very grateful to know that Illinois did something right for us. Barb S. [email protected] p.s. It really is insane we have to fight for our rights when it comes to insurance benefits. This has been a nightmare for me. I pray it works out.

Am I reading this correctly??? Has Illinois now passed a State Madate forcing insurance companies to cover Bariatric Surgery if the parient is 100 lbs overweight with co-morbidites? My insurance company had told me on the first call that I was S.O.L. because Illinois did not yet have a mandate. Is there hope?

I do not think that is what the original poster said. She said that a person is entitled to an external review of their case. Try reading what Barb S wrote again it may clear up the questions that you have.