Anyone had HR department overturn a VSG denial?

Hey folks, last week my first-level appeal for the VSG was denied by UHC based on the whole "unproven" and "investigational" thing. Blah, blah, blah.  Anywho, I'm not giving up, so off my appeals packet went to HR yesterday, which is the next appeal level.  Has anyone been successful in getting their VSG denial overturned through human resources?   

I have UHC with and exclusion rider and my boss is the person who designed the plan for us.  When I bought this up he said he would look into it and see about the rider... He came back to say that it is expensive.   Since he has a budget agenda in mind I am not holding my breath.  

I am not sure what you mean by a 1st level appeal abd why are you going to HR.  Can you explain  

I was seriously concidering getting all of my own medical histroy and doing it proactively to the insurance company

Thanks Gloria

 

Thanks for replying!  I work for a company with a self-funded insurance plan.  All this means is the insurance company (UHC) simply administers the plan, but my employer is the final decision maker and has the power to overturn insurance company denials.  I was denied by UHC twice and then took my case to my employer's HR department to see if they would reverse UHC's decision.  In the last week I've decided to have surgery in Mexico, so whether my company overturns UHC's decision or not is pretty much a moot point at this stage.    

DH company also has a self-funded insurance plan, with Americas TPA as the administrators and First Health as the Network.

Well First Health covers WLS, but DH company has an exclusion on it. Are you saying they could overturn their decision on a case by case basis?

I truly wish you luck hon!

Hi Tiffany, yes.  That means the ultimate decision lies with HR on a self-funded plan.  They have the power to make decisions on a case-by-case basis.  Since the employer is the one that chose the exclusion, I don't know if that's an easy one to fight, but my philosophy is that anything's worth a try.  Thanks for the well wishes.  I appreciate it!