WILL I STILL HAVE HOPE? PLEASE MY OH FAMILY HELP?
My OH family I need your help I found out that my WLS will not be covered it's excluded due to my Company not buying the Bariatrics package because they were selling toanother Company, so my Insurance for this year fell under my old Compan. I was deceaved during OE in my job when I called and asked Specifically if the WLS surgery was covered I called twice and they told me to even get the mose expensive plan to make sure everything was covered. Now I have done all the steps and while my Certificate of coverage was not available for my viewing from 01-08 till now To my luck it is excluded in the Limitations & Exclusions but there is a contradicting clause before it which says "thatsays that not covered if not Medically Necessary due to sickness or injury" so does this mean that if it is Medically Necessary will it be Covered? Please help my OH Family, and if anyone knows of any good sample appeal letter's please help me I am very dissolutioned but my PCPC says he is with me all the way to fight it. So this week all the paperwork is going to the Insurance Company.
EstherA
PLEASE HELP!
I think it might be covered with a fight (aren't they all fights though). I have one of the toughest insurances to get approved. Mine said the same thing. I just got approved with my appeal. If you would like me to show you my appeal letters and things let me know.
The good thing is, all those hoops you jumped through will still be good to use for usually 5 years. If you change to a job that covers it, you can get approved right away.
Lnz