Insurance denial

Hello-

I have been denied by my insurance company 2 times and I am at a loss.  I am going to file an appeal.  I friend of mine said that there are groups out there that can help fight the insurances or at least steer you in the right direction.  Is there anyone out there that knows of anyone?

If so please give them my email address.

[email protected]

I would appreciate all the help I can get.  I am morbidly obese and it is affecting my health.  I need surgery on my knees, I am on oxygen at night and now the dr. is worried that it is starting to effect my heart.

I have insurance but it is SCI Molina Healthcare.

Thank you,

Phyllis

I have State Coverage Insurance and all it says is no cosmetic surgeries.  Nothing about medically necessary weight loss.

I have the same questions--is it a policy exclusion? What were the reasons they gave you for denial?

If you need legal help, go to www.obesitylaw.com.

I will certainly look that up and thank you so much.

They are claiming is as cosmetic.  Can you believe it?  I have just written them a long letter explaining all of my difficulties with this weight and the complications that I have been having and the fact that if they are not taken care of now that it will just become worse and will wind up costing them more money in the long run.  Ie...hosptial stays due to a heart attack,  knee surgery due to giving out,  long term diabetic medicine and possible hospitalization  etc....the list could and does go on.

Thank you for the info.  I will be looking into the website.

God Bless,

Phyllis

What state insurance do you have? Molina Healthcare has a website, but it is broken down by state.

Weight loss surgery is not typically considered a cosmetic procedure. I would call them and specifically ask about WLS.

Hi Phyllis! 

I have hired the Obesity Law & Advocacy Centerto file my appeals.  It's a husband and wife team (Walter Lindstrom & Kelley Brown) and they have been specializing in this area for over 12 years.  Walter actually is a RXY patient. I hired them immediately after my first denial from United Healthcare.  While the process can take time (which is frustrating), I have found a lot of peace knowing that lawyers who specialize in this area are filing my appeals.  I am on my last appeal which is being filed with my company as they are the Plan Administrators.  I would hire them again in a second and even if I don't get approved in the end, I'll know that no stone was left unturned and that everything was done that could have been.  Below is their website.  Take a look.

http://www.obesitylaw.com/
 

Kelly-

I looked up the website and that is an option I am considering.  Is ist very expensive?   I am writing a letter to the insurance company requesting them to reconsider and a list of the reason why.  I am also sending the same letter to the Governor's Office per request of the lady who works there.  Yep,  I called the Gov. office and complained.  They are gonna to try to help as well.  This is rediculious.  I don't see how a company can cause so much trouble for a surgery that saves lives.  I am not looking to win a beauty contest.  Just a chance to live a normal life.

I thank you for all your help.

God bless,

Phyllis

Phyllis -

Contracting Obesity Law & Advocacy Center is not as expensive as you would think.   It would not hurt to contact them and explaining your cir****tances.  What I like about them as there is no bull about them.  If they don't think they can help you, they'll tell you.  I hired them right after my first denial letter and depending on the state you live in and the plan you're only allotted so many appeals.  Walter Lindstrom is a memeber of all of the leading Bariatric Associations and Societies and Associations and speaks at a lot of the conventions for the surgeons and the likes.  He and his wife Kelley know what they are doing. 

I hope it all works out for you and can assure you that you wouldn't be dissappointed with their services. 

P.S..  I promise I'm not being paid to write this :)  My surgery pre-approval is on it's 3'd and last appeal and even if the outcome isn't what I'm hoping...It will have been worth it!