Appeal update...yet another denial

Today I received a call from Kelly at Highmark BC/BS and she told me that my 1^st level appeal has been denied.  She is now sending everything for appeal to Alcoa (my employer).  So, Highmark has denied me 3 times and now I’m on to the Alcoa appeals people.  The only saving grace that I have is that all other insurance administrators that Alcoa uses (all unavailable in my zipcode) provide coverage for Lap-Band…..except Highmark.  That means everyone in my company but those covered by Highmark are eligible (if criteria is met) for Lap-Band surgery coverage.  To me, that’s wrong on a bunch of levels.  I’m paying the same amount of money as all of my other co=workers but, because I live in a different state, and stuck with Highmark from hell, I’m out of luck. 

 

 

So, here I am, still in limbo.  I guess I’m just frustrated beyond belief and the light at the end of the tunnel is getting dimmer.  I watched the biggest loser last night and thought that I should just try and do it AGAIN the old fashioned way.  I’ve done that a million times though and I always get the weight off  (at least a big chunk of it anyway) and just can’t keep it off.  I’m just a mess I guess.  I really don’t mean to be such a downer. This girl at Highmark just seemed really positive and I just felt like this one was the one that was going to work.  UGGGGHHHHHH, I just want to scream. 

 

 

Thanks for listening to me vent!!!

 

 

Gina B.

 

Gina, I can totally relate, just received my denial on my 2nd appeal, which means I have exhausted all through my insurance. I am now filing with NYS Dept of Insurance and am hoping for better luck. I figured after insurance denied me initially they would deny the appeals also. I was denied because the letter from my pcp wasn't detailed enough. I am seeing him next week with a letter I have typed myself from looking at numerous samples and will send in my appeal.  Vent all you want but keep trying I know it's frustrating beyone belief but I see posts from people who started this 2 years ago getting approval. What is you next step? I wishing both of us luck for a future approval.

Joy and Gina, I feel your pain. I also was denied twice and I am now appealing to the State of Connecticut Dept. of Insurance.  I had visited with my PCP for 6months and the insurance company said I didn't do it fully? Good luck to you on your journey.  Don't give up and let the insureace company win. JEN

Thank you both for your input.  I wish that I had the money for legal counsel but i don't.  I know that legal counsel would be the key to all of this, however, unless I win the lottery it's just not in the financial cards right now. I'm in HR and really love the company I work for in so many ways so it's hard for me to think of them as the enemy.....but I'm getting there!!! Thanks again for the advice and support. Gina

Gina: Paul is correct on every count.  I am dealing with a self-funded, self-insured company as well.  I have finally decided I am too close to the situation after multiple attempts to write additional letters to those that override the people I have been dealing with, so I called an attorney who specializes in my home state.  Trust me, after talking with our TPA I finally broke down the people and they themselves told me that my dh's company is their client and they do as they wish. Three different representatives even went so far as to tell me the one person who was not to have any access to my information was the one roadblocking it all.  One letter at about $150.00 from an attorney on his letterhead may or may not be enough, but if you start there and let the attorney start looking over your file of information, they can be forced to pay your attorney fees if there was any type of ADA violation, HIPAA violations or preferrential treatment given to other employees.  Take Paul's advice to heart. He knows what he is talking about.