I Guess I Was Wrong About Encouraging/Denied

I just got a letter from the insurance company that states I have a right to appeal, but also states that the benefits changed on my policy as of 1/1/03 and that bypass surgery is excluded. I am so devestated,

I am sooooo sorry to hear this news, Robin. Don't give up yet though. There are several in my local support group who were denied multiple times who eventually got approved. Sometimes the denial is automatic - the insurance companies bet on the fact that some people won't be persistent or won't get mad and fight. Sometimes when people fight back, the decision is suddenly overturned for seemingly no reason at all. Sometimes denials happen because there is a glitch with paperwork, or a miscommunication between the surgeon's office and the insurance company. Sometimes they need more information. It totally depends on the person who was responsible for reviewing your case. Did you write a letter of appeal yet? I have my letter I wrote and I would gladly send it to you. Did your PCP write a letter of support and of medical necessity? There are also legal options to explore as a last resort. Look at www.obesitylaw.org - they are a legal firm that fights insurance company denials and uses their own approval history as well as the Americans with Disabilities Act to argue a discrimination case. Frequently all it takes is a letter from them. There are many avenues that can be explored - again, I am so sorry that your request was denied. Please don't give up and don't be too discouraged yet. Stay strong! If you want my letter to my insurance company please post or email me and I'll send it to you. HUGS - GVJ

Robin, You need to appeal. Write a letter list all your health problems, send them copies of your medical files. Send letters from any and all Dr's that are treating you. Last send them pictures of your grandchildren and tell them you need to live for them. Good Luck.

Robin - I am sorry to hear you got a denial letter - but this is just a stepping stone. Insurance companies try to avoid paying. If you need help on this let me know - my doctors wer very impressed with my letters - not that they'll help you, but it is worth a try and I would make sure they totally understand you are NOT backing down and you will fight until you get their approval! Keep in touch - I will talk to you tomorrow. It is NOT over - unless you let it be! I am here for you!

Robin, Glad to hear you are uncurled and still alive (read your profile). I know this must be frustrating, but please don't give up on yourself or this surgery. Fight like heck. I fought workers comp for almost 3 years. It was exhausting, discouraging, etc, but I called my lawyer all the time, sent letters and faxes, bugged workers comp, etc. I never ever let them forget my name or who I was - I stayed on top of everyone...and it finally worked in my favor. I never thought it would end, but I wanted to make certain that everyone knew my name and who I was. PLEASE KEEP THE FAITH. I have seen you on this message board being so supportive of others, and I hope you will show yourself the same kindness. I'll add you to my prayer list. I am still pre=op and our journey is just beginning, but I want to wish you many many blessings and much encouragement. melissa philbrick ps - i just moved to the florida panhandle with my husband last november from orlando, and my inlaws live in apopka. my husband is going to graduate from seminoe community colege hopefully in december (taking his last class distance learning)....so sanford is very famiiar stomping grounds for us.