Got denied for the 2nd time now

I got my second denial letter. I feel as though my world has crashed and burned. I am looking for suggestions as to what to do next. I guess its back on the yo-yo diets for me. Any advise?

Did the letter say why you were denied?

Ohhh.. Jennifer please don't give up.. what was the reason they gave you the first denial? Was it different from your second one? What did they both say?? Did they want something more from you? ((((((((((Jennifer))))))))))) Stef

My advise? DONT GIVE UP!! They EXPECT you to give up!! Find a contact person at your ins. co...and create a relationship with him/her. Find out from this person EXACTLY which criteria you are not meeting. Speaking to a different person each time never helps Our collective fingers are crossed for ya!

They told me that I had a special exclusion to wls on my policy. However I know for a fact there is not. If you talk to the insurance company for a preapproval they say its covered however the approval department keeps denying it for some reason. The surgeon is going for a 3rd approval now. I am now thinking that this is not meant to be. I keep getting denied for a reason. As my weight is still a huge issue I am going to give them a 3rd try at it. I am going through alot right now (just bought a house and trying to sell my house) and am under alot of pressure. Everything happens for a reason and a purpose and at the right time. I just am so lost right now as to whats my next step.

Jennifer, oh I am so sorry that you have to go through this with all the other stress that you are under. It will be so worth while in the end after all the dirt is settled. You have a fantastic group that you went with. There are many on this board that have gone with the Kane group including my husband who had Rantis. Are they going to keep fighting for you? Have you considered an attorney to help with the process? I know they are expensive but if you are being denied your rights, they can fight for you. And yes, everything happens for a reason, I am a big believer in this. Keep us posted. xoxoxoxoxo (you need some right now)

Can you check your policy yourself. Ask your HR department. I know that we now have UHC, and that UHC was not covering WLS at all this year, when new contracts were being renewed. Just check...because if it isn't an exclusion at all on your policy, keep fighting, and like another poster said, find one person at UHC to contact, when you find that one person that is helpful and understanding as for his/her extension so that you can always call that one person back. I know that this helped me out when I was appealing and trying to find out what information I Was missming. Tricia

I don't want to tell the HR department yet of my plans so how can I find out if its covered? Is there a book I ask for or something?

There should be an 800 number on the back of your card. Member services number. Call that and give them your group and policy and they should be able to tell you what the policy covers. I have BCBS and was able to get an explaination of benefits of the internet that listed exactly what paperwork I need to submit in order to be covered. The denial letter should list a reason why they are denying you (is it because it is not covered, or becuase of incomplete paperwork or something?) Good luck - keep fighting this!

Jennifer, Ask your HR department for a "Summary Plan Description" of your medical pollicy. You don't have to tell them why you want it. Before I was disabled I was in HR for 20 years so I know....the SPD will tell you everything....probably more than you really wanted to know about your benefit. Also with the HIPPA Privacy law they can't really ask you private questions about your medical stuff. Don't give up!!!!!