Need advice

sharroona
on 8/17/08 9:11 am - forest grove, OR
Well im having insurance run around there is an exclusion in my policy, but it can be covered "but you have to jump through hoops" is what i was told........whenever i speak with them they just tell me its excluded and when i read the policy  which states treatmet for obesity primarily for weight loss or control is excluded, but this shall not exclude procedures that are necessary due to a specific condition caused by another illness or for morbid obesity as determined by plan..........so the nurse at insurance told me my chart from ohsu only says that im overweight and just need to loose weight ....which im sure it doesnt......so she said i dont have any illnesses and when i ask well what is morbid obesity as defeined by  plan she says she doesnt know......so i called H at ohsu she says there nothing she can do until they deny me and I left message twice for NP to call insurance company... ive spoken to corp head quaters of my company from insurance is from ...im currently getting run around on that ......call this person, then get refer to another person..........does anyone know who i should call or what i can do .........it doesnt seem like anyone wants to help me and so im trying to figure out what i can do besides wait around for a denial letter that just seems silly to me.....my paper work was submitted to insurance com on July 18,..........they havent sent me anything back official.........thanks
musik
on 8/17/08 5:26 pm - WA
Usually insurance goes by BMI and co-morbidities. In order for my insurance to cover you have to have BMI of 40 or BMI of 35 or more and 2 co-morbidities. Doesn't your plan give you specific definitions? I might try calling insurance again and try speaking to someone else who can give you specifics. Im sorry about your insurance issues! Keep trying, I know its hard to be patient but be persistent!
Brenda
sharroona
on 8/18/08 6:28 am - forest grove, OR
I called headquarters today and they told me " i have to have a serious illness like stomach cancer or heart disease " I when i asked about comorbidities like diabetes, sleep apnea, ect she said no to all of them.......and wheni asked for something to be sent to me with the illness and there definition of morbid obesity she said no its in your benefit book ...i told her its not and she ignored my request....so now ive contacted employee benefits security admin depart of labor to see if they can help me........but im pretty broken down and dont know how much more dissapointment i can take...this journey has been so hard and its looks hopelss for me and i dont have any other options.................
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