Would like your guidance…will try to make this long story short, but want to give you some background info. In 2010 I had Lapband surgery lost 90 lbs and committed to a healthy lifestyle. In 2011, I had the surgery reversed because of the procedure failing and causing major medical issues due to erosion. I am trying to have my surgery to fix the procedure, but they can’t do the same procedure because of the same complications so they want to use the gastric sleeve.
The request to the insurance company and my benefits department at my actual company were denied as were my two appeal due to “One surgery per person per lifetime". They said I've exhausted my two appeals and the corporate benefits people keep referering back to United Healthcare's one surgery per person per lifetime.
I'm at a loss here trying to get them to understand that this is a very different situation, and while I understand the need for the policy due to people trying to use multiple surgeries as a “quick fix", this really an exception to the rule…I’m not trying to have a second procedure, I’m trying to correct the one surgery (procedure) that failed. Had my “one" procedure not failed me, I would still have it and still be doing incredibly exceptional. I'm also at a loss as to who I should be fighting this with....
Just wanted to get your thoughts on who I should appeal to or what help is out there? I can't afford a lawyer and with my company telling me there isn't anything else I can do, I'm not sure where to go
