Strike #2

Needless to say I think the tag says it all.  I got a letter yesterday that made me cry, BIG TIME.

United Health Care Sent me a denial to my appeal.  Quoting again that wls surgery is not a covered service and they are striclty regulated by federal and state laws in administering the terms of the health insurance policy.   But what I find intersting is that they directed me to the Maryland health education and advocacy unit right here in Baltimore and also the saying I can file a complaint with the Maryland Insurnce administration.  Now lets stop and look at this for a moment.  If the Certificate of Coverage states they are regulated by the California Department of Insurance, why would they direct me file complaints with Maryland Insurance Administration.

The letter states they are required by federal and state laws. ok that being said are they telling me that they must abide by Maryland State law and the only way to get around the exclusion is to persue it with the Advocacy Unit and a grievence with the Maryland Insurance Administraton?


I find this interesting.  Comments, advice welcome

and I have already contacted the Health Education and Advocacy Unit and waiting for a response.

Zells_lori is 'abuddignrose'

Was this after the independent doctor review?

Sylvie:

No independent medical review has happened yet.
this is my first appeal.  I will keep you posted.

Zells_lori is 'abuddingrose'

I am so sorry you got this sad news. I will say that I would not give up and I would continue my pursuit in order to achieve your goal. I am sure that you can prevail and eventually you can win this battle. I am here for you and I wish you well in your battle. If I had the extra $$$ I would help you self pay. To bad I did not win the Mega Millions. I could have helped so many people...

                                                                                                    Julie

Julie:

thanks for the support, I am not giving up. I did cry last night as I was reading the letter.  to no suprise.  I have already contacted the Health and advocacy unit and if they are bound by state law then they are required to cover the surgery and was telling me so in the letter when they told me to contact the advocacy center the insurance administration. What I find ironic is that the state Insurance Administration told me they couldn't do anything if they policy was written in california.  So we will see what happens.



Zells_lori is 'abuddingrose'

Grrrrr!!!  How very frustrating, but on to the next step.  Still thinking good thoughts!!

Heather:

Frustraiting yes, but like you say on to the next step.  Thanks for the good thoughts I can use all the help I can get.  I may get discouraged at times, like everyone else. but I REFUSE TO GIVE UP.  Its not in my creed.
It is the squeeky wheel that gets the grease.


Take care Heather and hope to meet you at a gathering sometime.

Zells_lori is 'abuddingrose'

Good luck Lori!  Stay positive.

Ren

Ren:

thanks and I am really trying.  I just spoke with the Maryland Health Education and Advocacy Unit and filed a complaint.  They help mediate for getting patients what they need.  As soon as I get the paper work I will be sending them the entire packet.  And after going to the dr tonite to get the results of the MRI/MRA will most likely have more to include ie hypertension uncontrolled with medication.


How did pete like the idea of being the little monopoly man for Halloween? lol


Zells_lori is 'abuddingrose'

Aw Lori, that sucks. I was really hoping it wouldn't be a hard battle to win.

Good thoughts and crossed paws coming from my house.