Hi, I'm New Here...Need Advice on INSURANCE!
Hi 
,
Just a little introduction before I ask my question. I'm a 40-year-old single mom of 3-year-old twins 
(boy, Jaime Alessandro and girl Jordan Gabrielle) from Akron, Ohio. I work in the Communications industry as a Supervisor and have been there for almost 7 years.
I had a consult at St. Vincent's a few months ago for WLS. I am sold on the program and the Surgeon, Dr. Ben-Meir and wanted to proceed asap 
. Since several of my co-workers had been approved by their insurance (a few had the exact same that I have) to have WLS covered this year, I thought it would be no problem...wrong! I have the same, if not higher, BMI than them, and was shocked when I received my denial letter a few months ago! 
They denied because my insurance has an exclusion for WLS; however, taking in to account that I KNOW these coworkers got it covered with the same exact plan I have, I am going to appeal until I cannot appeal anymore. I think it's discriminatory that they got it covered and I didn't. I have 3 letters from specialists stating that I need the surgery to correct other physical problems and issues (sciatica, carpel tunnel, knee pain, gastric reflux, etc...) and will submit those with my appeal.
I was hoping some of you could give me some advice on how to appeal successfully 
...and how I can use the situation of other coworkers being approved this calendar year, but being denied myself. I've got to get this appeal letter in asap, so if you could be so kind as to reply at your earliest convenience, I'd be forever grateful! 
Off the subject (kind of), has anyone gone to Dr Ben-Meir at St. Vincent's and how do you feel about him and your experience there?
Thanks in advance. I hope to get to know you all soon, thanks to this board, which I found, luckily, by accident! 
Liz 
,
Just a little introduction before I ask my question. I'm a 40-year-old single mom of 3-year-old twins (boy, Jaime Alessandro and girl Jordan Gabrielle) from Akron, Ohio. I work in the Communications industry as a Supervisor and have been there for almost 7 years.
I had a consult at St. Vincent's a few months ago for WLS. I am sold on the program and the Surgeon, Dr. Ben-Meir and wanted to proceed asap . Since several of my co-workers had been approved by their insurance (a few had the exact same that I have) to have WLS covered this year, I thought it would be no problem...wrong! I have the same, if not higher, BMI than them, and was shocked when I received my denial letter a few months ago!
They denied because my insurance has an exclusion for WLS; however, taking in to account that I KNOW these coworkers got it covered with the same exact plan I have, I am going to appeal until I cannot appeal anymore. I think it's discriminatory that they got it covered and I didn't. I have 3 letters from specialists stating that I need the surgery to correct other physical problems and issues (sciatica, carpel tunnel, knee pain, gastric reflux, etc...) and will submit those with my appeal.
I was hoping some of you could give me some advice on how to appeal successfully ...and how I can use the situation of other coworkers being approved this calendar year, but being denied myself. I've got to get this appeal letter in asap, so if you could be so kind as to reply at your earliest convenience, I'd be forever grateful!
Off the subject (kind of), has anyone gone to Dr Ben-Meir at St. Vincent's and how do you feel about him and your experience there?
Thanks in advance. I hope to get to know you all soon, thanks to this board, which I found, luckily, by accident!
Liz 
Good luck.
Linda
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