External Review

So I sent off my 3rd appeal to my insurance department.  "Phil" from Highmark told me to.  He said do it in 15 days or less.  Then it will be sent to the PA Dept. of Insurance.  Well, Phil just called me to say "Oops, I was mistaken.  You don't get a 3rd appeal."  I look deep into my policy and sure enough, he's right. 

After my 2nd appeal it says I can file a grievance with an arbitrator.  Doesn't this mean an external appeal?  I am so friggin lost!  I live in Indiana and Highmark is in PA.  Who do I contact?  My dept of Insurance or PA's?  And don't I have to hire an arbitrator?  Who do I call?  Is it expensive?  Anyone with any guidance.... please help me.

Have you considered the obesity lawyers recommended here?  From my understanding, they are really good with over 90% overturn for approval.  I know they charge $450 for an appeal but since you're working on your 3rd appeal, it might be more.  It would certainly be worth contacting Gary Visco.  I emailed him about my situation (before I even filed my first paper) and he sent me a personal email reply.  While I ended up not needing his help, I would still recommend him to you based on my little contact with him and how much others rave about how he/his firm helped them.

Thanks for your response.  Since I have posted this, I learned my hubby can file a grievance through his union.  That is my next step.  After that, who knows?