Angry and hurt (need advice)!!

Ok, I'm here and I need some help. Right now I'm so angry at my insurance company (Humana). So I've been looking into WLS and back in May the bariatric center verified benefits. Humana told them I have NO pre-existing clause and that WLS is covered under my policy. So then this week we find out Humana sticks a pre-ex clause on my policy and now I'm not covered for WLS. I'm so hurt right now. It's truly unethical and inhumane to let a person believe that there could be a way to finally be healthy and achieve happiness. The insurance cooridinator wants me to appeal this to the end, as she is ANGRY too. She wants me to contact the attorney general and make a complaint with the insurance commissioner of our state, and appeal EVERYTHING! So, I need help..where are some appeal letters to help me follow?? I need advice!! ~N

I don't get it.There was no pre-ex clause in May & you haven't changed insurance this year & now a few months later it's in there. It sounds like fraud to me & I'd appeal & contact a lawyer. It took me almost a year to get approved due to my insurance Co jerking me around. I called every week in '06 until they got sick of hearing from me! Don't give up & document who you talked to & the date & what they said. Insurance Co can't stand it if you're prepared.

See, In May Humana told the insurance coordinator at the surgery center that yes, WLS was covered. So since they told me that I went ahead with test, etc...then in June they began denying claims. I got on this policy in Feb and they waited 4 months to apply the pre-exist on there, but regardless they lead me and the doctor to believe that WLS was ok. Then today I find out they denied me saying there was an "EXCLUSION" and that no WLS is covered. I was just lied to the whole time. Surely there is something I can do about it.

I may be able to provide you with some information.....please email me.... [email protected] Sherri

Well, I can go one further than that. Hummana approved my surgery,****pt the letter) paid for all of my pre-op. After surgery I received a 19,000 dollar bill from the hospital. Called Humana they said it was not approved. I told them I have a copy of the letter and my dr. would not have done the surgery witout the approval. They re-submitted it with the numbers from my letter. I talked to them on July 10th. See how much fighting I have to do to get them to pay.

Believe it or not, I just received a package from my insurance company and inside was a sample appeal letter. Since this is only an example form letter, I hope it is ok to post it to you. If not, I apologize to the higher power of the message board. :) (put your name) (put your address) (City, State, ZIP) (Your phone number) (Your insurance ID number) (DOB: Your date of Birth) (Put the date) (Put the Insurance Companies Name) (Insuarnce Co. Address) (Ins. Co. city, state, zip) To Whom It May Concern: I am writing to formally appeal denial of : (refer to the services you are appealing and put it here). I am covered under your plan and my ID number is (put ID number). On, (put date), I attempted to (put what you are trying to have done -- name of surgery, etc.) at the (name of doctor/facility and the address). I was told by (name of person you spoke with & you could go ahead and mention the fact that you were covered on that date), and as of (new date) you are not covered. I decided to (list action you are taking). My contact information is above and contact information for Dr. (name of physician), is listed below. (Put name of physician/facility) (Address) (City, State, Zip) (Physician's Phone Number) (Contact name) Dr. (name of physician) recommends the surgery, and you may contact his office if medical information is needed for consideration of my appeal. I have included a copy of the (whatever you are sending with the letter, if anything (maybe a copy of the previous approval, or a copy of your insurance policy before your approval date) -- if you have nothing to include, you can leave this line of the letter out)). Please provide me with a written explanation of any additional steps I must take for you to process my appeal, as well as a written explanation of the basis for your decision about my clain. Sincerely, (Sign your name) Enclosures (if any) I hope I have been a help to you. Good Luck. I am awaiting postponement of my surgery also. So, I know how let down you feel. But, don't give up!! Just some red tape. Show them you will jump through every hoop to have it done!! I will be thinking of you as I jump through my hoops too!