Documentary
Gary
email [email protected]
www.ObesityLawyers.Com
RNY 7/1/03 -166lbs
my problem is a bit different. my insurer is HIP-prime, and has been since i started to pursue WLS in november 2007. i had a heart attack 4/07, then a tiaa 8/07 i have been out of work since 8/9/08 for those two issues, as well as for my other co-morbs, type II diabetes, htm and extremely high cholesterol. i was diagnosed with metabolic syndrome. HIP has paid for ALL related treatment and testing thus far, so that is not the issue. since 4/07, i have had 4 cardiac stents placed, and each of my treating doctors agreed that i needed wls to help stave off 'clotting out' my stents. they also recommended that i remain out of work pending outcome of the surgery. the first set of docs had me set for surgery 4/9/08, but it didn't go off. i finally DID have my surgery 6/3/08. here is my problem. back in 3/08, when the first cardiologist cleared me for surgery, MetLife, the db carrier, determined that despite being recommended to stay out of work pending surgery, i was able to return to work, effective 3/19, the day they denied further payments. i am in appeal, but now there's another problem. as i said, i finally had surgery 6/3. i reported it to metlife 6/2 - in good faith. however, i have just received a letter stating that they denied me because i didn't file the report within 8 days after the db started. huh? are you getting this? the main gist of my problem is that i have NOT been paid by my db carrier since 3/19/08. i thought they would pick up pmts after the surgery, but they have refused, because i filed the claim the day BEFORE the actual surgery. can you help me, or at least direct me to someone who can?? i am at my wit's end! denise howell [email protected]