Stop The World! I Wanna Get Off!
Oy!
OK - You all know my sad little story about the "exclusion" in my insurance policy in regards to WLS not being covered that caused my meltdown last week, right? Well, no one on the NC message boards had run into this, so I told my "tale of whoa" on the main board to find out if anyone has gone through this. A few people responded and it turns out that a few have been turned down initially due to that "exclusion." One gal said that even with the "exclusion" they will cover you if you're twice your ideal body weight...which I am. Yay! (huh?) Anyway...another gal said that she appealed when they denied her too. She said the "exclusion" they talk about says WLS not covered...UNLESS you are morbidly obese, but peeps at UHC never read that far along. Duh! Then they covered hers.
I called Kelly at Dr. Harris' office to see if she has heard of this. Yup! She also told me I have not been officially denied yet. They have no letter or anything from UHC and without the letter, it may still be pending approval. She said if I am denied, she strongly recommends that I fight them on it. With a BMI of 60...yes, folks...six zero...she cannot believe that they would deny me.
So there is my update. The ball is still in play. (Atleast that is today's story.)
My head is spinning from all this nonsense. I shall try to be patient for a while longer...but won't make any promises.
Have a good day all!
:o)
Mary Ann
Oooh, ooh, Mary Ann Call your cust serv rep at UHC and make a friend of her. Get her in your corner and get her to help you jump the hoops!
I had a similar situation with BCBS ILL PPO originally. They said I didn't have a five year history of MO and I didn't have a six month medically supervised weight loss program. Well, I did, it was in the paperwork, the initial reviewer just didn't see it. So while they are typing my denial letter, my bestest friend at BCBS (Debra) starts chasing stuff down. She resent my paperwork up to the medical review folks three times. And I got approved. You go for it girl!
Mary Ann,
I fought the system for three years not just the insurance company but all the pre op testing ect....
It was a pain to have this carrot dangling out there for the SMO and talk about hoops I jumped through them all.
I was denied twice with bcbs and I ended up writting an appeal letter which I hand delived to them and within two weeks I was approved.
Fortunatly my nieghbor works at bcbs and he helped me so much by explaining things to me and emailing me he became my champion.
I also heard that if your doctor feels surgery is medically needed then he/she has the magic pen when it comes to the insurance company.
Also it is part of your doctors job or their nurse to work with the insurance company.
Dont stop fighting !
Annie
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