Denied by Insurance for the 3rd Time (x-post)

Unfortunately, I had to delete this post due to privacy concerns.

You're welcome, Shelli. I hope she can help you.

At what point in the denial process would someone need to contact a lawyer? After the the first denial? Second?

A lot depends on your individual situation. Everyone's insurance situation is different, and the appeals process is different according to where you live. Some states (not mine) have an external appeals process that exists outside the insurance companies. A lot of that can be navigated on your own, but I wanted help because I was feeling a bit out of my league.

Karlene isn't an attorney as far as I know (hell, she may be...I never asked), but specializes in preparing insurance appeals and helping to "convince" insurance companies to pay out the money they are legally contracted to pay.  I contacted her immediately because my insurance did not cover DS, period. I didn't wait for a denial. She was with me from the beginning. But of course we didn't file an appeal until we had the first denial. And since my insurance was self-funded by my employer, the appeal was made to my employer's corporate offices, not to Blue Cross. I could have done all of that myself, but she was much, much better at it, and as I mentioned, her fees are incredibly reasonable. Like, less than I've spent in the tanning bed this summer.

Thanks for that info., Anna! Knowing as much as possible beforehand makes me feel like I actually have half a chance of getting coverage for my DS.

Just for the record, I contacted this person for help. She worked on my appeal for 4 months & didn't make any progress at all. I do not recommend her to others who need help with an insurance appeal. Although Walter Lindstrom is more expensive, I think it would have been a better choice.

Shelli, I'm sorry about the denial, but the fight will continue. Keep in mind that insurers don't need a good reason for their denials, they can just say no regardless of the quality of your appeal, the merits, the facts, etc. You ask what more you can do to convince them, but there is nothing you can do or say because they don't want to be convinced. That's why it's necessary to have an external appeals process.
     So don't give up, just fight upwards to the next level, and keep going til you get to the external appeal, which is where you have a chance. It costs them nothing to say no, and they are hoping you will just go away. But you won't.

Larra

Unfortunately, I had to delete this post due to privacy concerns.

Hi Shelli,

I am so sorry to hear about your denial.  Don't stop and keep fighting.  Its a shame that these insurance companies do this to us as we are trying to get healthier, but I guess they like us sickly since they don't have a problem paying for multiple prescriptions for co-morbs. 

You will get your approval, you have to fight hard to get it.  I will keep you in my prayers.

Frankie