Appeal Letter Response!

WELL I am steaming mad!! I spoke to the HR person *****views the self-funded insurance appeal process at our hospital... They have made changes in the policy (increasing the copay for WLS to $5000 and requiring 1 yr employment prior to surgery) that are effective retroactive to Oct 1, 2005!! SO he tells me that I have been approved for my surgery AFTER I complete a year with the company and pay the co-pay!!! That would mean waiting till July!! So basically they're trying to change the insurance policy NOT at the beginning of the new year, but retroactive until just after Katrina! Talk about getting screwed over. I'm fighting for my surgery, without the unfair application of policy changes for NEXT YEAR... Since my surgery would have been approved in 2005 had they not denied me... SO.. I've been approved!!!! Now I only have to fight for the right to apply the policy as it was in force at the time of my original submission for approval... not as it is by the time they stop stalling me... Kat

Fight them girl, you have the strength within you to do this and I know you will. Holding you in prayer daily for a quick response and no more waiting. Gina

Kat, I am so sorry you keep getting the run around. I know you have worked so hard for this. I am so sorry. Just take everything you've got an fight. Will be thinking of you. JC

Im sorry Kat the insurance folks given you a hard time. Trust me I dealt with it, i work with a hospital, self insured. But my hospital quit paying after a couple of adminstrators got it. Sounds like you have a bigger chance than me. Good luck and we are here to help in any way... Rhonda

Hey Rhonda... No Name has got a great point! Not to mention being very helpful in my letter composition It's worth a shot to get your surgery costs returned to you... not to mention helping others who may be in your position

I agree with Gina here. You are a tough lady and this will fly by before you know it. Just remember, all things happen for a reason. I will continue to keep you in my thoughts and prayers. Keep your head held high. I heart tells me this will happen soon for you Group Hugs! Dee