Got what I expected

Happy Monday every one.  I hope you all had a great weekend.  My friend stacey and i went to AC for the week end.  When we got home my mail was waiting to be opened.  I received a letter from my health insurance company and it said what I expected it to.  They denied covering my wls because it is listed as an exclussion.  Of course I am working on the appeal as we speak.
I am compiling my list of articles, case law, stats, and personal plea to see if they will work.

Wish me luck we are off to win the battle.



Hugs from Baltimore


Lori

Best of Luck Lori.

Of course I may be stupid but how can you appeal something that's not covered for anyone?

I mean if the insurance excludes it for everyone how is that something you can appeal?

Nessa:

No your not stupid and right in the letter of denial for coverage it explains that you have the right to appeal and what the steps are .   The fact that the surgery is medically necessary, there is a state law that makes coverage for wls  requried and case law that states the laws of the state where the insured resides can not be ignored makes appealing a good idea.

If things are excluded the insurance company feel that when people see that and /or get the denial letter they are finished and will give up.  Not me  I am going to fight for what I need.  I know there is no gaurantee that I will win but I have to try.  I am worth every effort that I am putting forth and so is everyone else that may be helped by appeal if I win. 

Will keep you posted.

Hugs from Baltimore

Lori

They call it an excluded thing, but Maryland state law has that all companies over a certain size have to have the bariatric coverage.  

I have a friend who works for a company smaller than the size that has to have the coverage.  He got the same denial letter.  He fought it and got it approved!  Good luck!  Keep fighting it!

well that's good news for Lori then.

OMG!  Do NOT think I agreed with your "i might be stupid" part!  :)

You are not stupid at all.  It's just the insurance wording and lingo.  And my post wasn't aimed at you, Nessa.  :)  I hope you didn't take it wrongly (I'm guessing you didn't, but I want to be sure!)  You know I adore you, Nessa!  :)

NOT at all!  It's ALL GOOD.  I didn't think it was that way at all.  Of course with my ADHD I tend to miss a lot of  subtle things...

I guess i"m very spoiled with my good FEDERAL BC/BS.  Everything (but abortions) are covered in some way shape or form.  We don't even have to worry about approval it's a given.

I understand.  The State BC/BS is good too!  :)  We are very lucky!  I only know about this stuff from my friend's battles with his insurance company...

Lori,

I pray that you do get it over turned.  Wishing you all the best in your fight to win this battle.

Hugs,

Best of luck Lori!