Insurance Nightmare Please Help
(deactivated member)
on 7/27/09 11:46 am
on 7/27/09 11:46 am
My surgery is scheduled for next Monday, 8/3. My surgeon's office called today to say my insurance denied me because I "...am noncomplaint, gained weight on my 6 month supervised diet even though I had seen a nutritionalist and that I need to do 6 more months on another physician supervised diet."
First of all, I never saw a nutritionalist in my life except for 2 weeks ago (pre-surgery meeting), I didn't gain weight on my 6 month diet, I stayed the exact same weight and prior to the 6 month physician supervised diet, I had another doctor who just put me on a diet and made me keep a food diary/ exercise log for 6 months.
They said they aren't denying the fact that the surgery is a medical necessity for me. The surgeon's office said my denial letter is very harsh and they see no way in heck that the insurance company will change their mind (they have until Wed. at 4 p.m. to make their decision final.
So, I called the insurance company to ask if I could talk to the review department and they said NO! After speaking to two member services employees that barely spoke English and one supervisor, I've gotten NO WHERE. I asked them to document that I've already contacted an attorney and I will take this to litigation since my health has drastically declined in the past 4 months since I've completed my 6 month diet and have been waiting for the surgery (things are only getting worse) as well as the fact that I filed a complaint with the state's insurance commission today. (I did so immediately.)
Does anyone have any more ideas on what I can do? Has anyone ever played hardball with the insurance company out of the gates and gotten anywhere?
Thanks for any help anyone gives me. I'm desperate and devestated to put it mildly.
First of all, I never saw a nutritionalist in my life except for 2 weeks ago (pre-surgery meeting), I didn't gain weight on my 6 month diet, I stayed the exact same weight and prior to the 6 month physician supervised diet, I had another doctor who just put me on a diet and made me keep a food diary/ exercise log for 6 months.
They said they aren't denying the fact that the surgery is a medical necessity for me. The surgeon's office said my denial letter is very harsh and they see no way in heck that the insurance company will change their mind (they have until Wed. at 4 p.m. to make their decision final.
So, I called the insurance company to ask if I could talk to the review department and they said NO! After speaking to two member services employees that barely spoke English and one supervisor, I've gotten NO WHERE. I asked them to document that I've already contacted an attorney and I will take this to litigation since my health has drastically declined in the past 4 months since I've completed my 6 month diet and have been waiting for the surgery (things are only getting worse) as well as the fact that I filed a complaint with the state's insurance commission today. (I did so immediately.)
Does anyone have any more ideas on what I can do? Has anyone ever played hardball with the insurance company out of the gates and gotten anywhere?
Thanks for any help anyone gives me. I'm desperate and devestated to put it mildly.
(deactivated member)
on 8/4/09 8:22 am
on 8/4/09 8:22 am
They have denied everyone, citing that the 6 month diet needs supervised by a dietician as well as a doctor. Everyone that didn't complain was advised to do 3 more months with a dietician and a physician. I complained and I got 6 more months. CRAZY!!! It's in appeals, but I've already started my 6 month diet...just like I did exactly one year ago...and still no surgery!!!
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