How hard is it.....

to appeal insurance??  i only ask because i explained my situation to the insurance person at health east and she told me its nearly impossible  

It can be done, there have been a few on here that have done it and have gotten their approval the second time through. It depends on your group however. If it said originally they don't allow surgery  at all, then you will not be able to appeal. However, if it is a surgery they allow, you can have your PCP send letters, family, friends, surgeon all about how this surgery will affect your life for the better and possible save your life in the long run. Talk to your surgeon, get the book that shows what they do and don't allow, and good luck to you.

thanks, yeah its not covered at all by my company, when i called to talk to the insurance company there were suprised as hell.  so i guess the insurance lady was correct.  i guess a funeral is a lot cheaper than surgery because thats where this will come to  

Have you looked into Minnesota Care at all? There are income guidelines, but it may be a possibility for you, and they do cover surgery. Also your insurance may not cover the actual surgery but do they cover medically supervised weight loss. I realize this is not the same as surgery believe me, but at least for now it could be a short term solution to give you time to find a way around the insurance, or to get independant insurance down the road. I am so sorry you are going through this, it is scary to be told what you are and aren't allowed to do for yourself medically by an insurance company that doesn't even know you.

so you have an exclusion in your policy?  is it even a tiny bit ambiguous?   sometimes just the way the exclusion is worded can help you fight it.  You could try hiring a lawyer who has experience with this kind of situation.  I believe Gwen aka doodlebug used an attorney to fight for her approval.. good luck

I'm so sorry, I know how devasting this news can be!
~HUGS~
I hope you are able to figure something out....if not, the suggestion of a medically supervised plan is something to consider.

 

Side note: Nichole- WELL PUT! It is ridiculous that insurance has so much power over our medical decisions when, as you said, they don't know us!! CRAZY!!!

So sorry to hear about your insurance.  I sure hope you can figure something out.  Let us know what happens.  Sorry I don't have any advice for you, but I can send up a prayer.

 

 

thanks all,  i have a full time and a part time job so county assistance probably isn't an option either although everyone keeps telling me to take a shot.   i don't know what the policy exactly says but Park Nicollet were the ones that told me it wasn't included in MY COMPANIES policy.   they never even submitted it. just told me they already knew my company didn't cover it  

Jennifer at PNC is excellent at knowing which insurance companies cover what.  I'd check with your insurance company again after the 1st of the year -- maybe policies change at that time.  Can you sign up for a different coverage during open enrollment right now?  Maybe the insurance company with your employer has the exclusion but another may not (i.e., BCBS versus Health Partners).  Just another option.  Employers have this exclusion so that the cost is cheaper for the company and employees.  I know this year BCBS at my company is excluding asthma care.  But Health Partners and UHC didn't have that exclusion.

And with MN Care -- all they can say is no!!!  Give it a shot.....

 

already enrolled for the same medical plan which was the only one available