How many appeals does it take?

i'm so very discouraged.  a co worker is on their 3rd appeal and ready to give up and i haven't even started the process yet.  our company has an exclusion as some of you may know from my previous posts.   i may give up before i even start

My best advice to you:  If this is what you want then you go after it with every ounce of fight you have.  Knowledge is the key.  First call the insurance and ask for EVERY specific requirements, which doc/hospital is covered, and what you can do to help.  Use that as a starting point.  Look at your coworker and ask if you can look at his submittal, and the 2 appeals and see what is missing so that you don't miss a thing.  Insurances are looking for that "one thing" and that you meet all requirements.  Then ultimately, the decision is theirs.  I am in the process of appeal for PS and I am learning lots!  It's soooo frustrating but keep your eye on the prize.  Each one of us have had some sort of "bump inthe road" "hurdle to overcome" and we each fought to get thru this.  If you give up it shows them you are not serious about it.  I hope that helps you.  I hope you find peace and strength to do what is right for you!

What insurance is it? I may have some contacts for you depending on which insurance it is. Employer exclusions are hard, but they have been beat so keep your chin up!

If the employer is self-insured that means that they pick the benefits not the insurance company. So, if  WLS is listed as a exclusion on the plan rarely will an appeal get it covered.  The employer would need to sign a deviation for that specific patient to have the surgery.  I work in health care and I can tell you that is hardly ever done.....unless you are an officer in the company. I don't know what you do for a living but  my  advise would be unless you want to self-pay-  get a different job.  If you have had continuous coverage under your current plan you will not be subject to prex.   The only plans that I am aware of that limit WLS are smaller self-insured plans or some unions,  everyone else pays. Maybe if your employer lost two good people because of the exclusion they would change the plan??  Just a thought.  Good Luck!

what is prex?  pre existing?  i only work for the largest wireless carrier in the world.  :(  getting another job is pretty much out of the question because i don't want to have to wait 30 days for insurance and i  have enough money issues the way it is now.  i don't need to take a pay cut getting a new job.  I'm so lost right now with surgery i have no idea what to do.  I haven't even started the process because everyone is so negative agains the exclusions as this post is.  i know its just being honest about it but it really sucks.  if anyone has a job for me with $14/hr hit me up.  otherwise i can not get a new job. 

I dito Sandie! YOu fight for this!!! We will all fight along side you.  Hugs, Lori