Question for Gary or anyone who might know the answer.

If an External Appeals Board overturns an insurance company's denial, can the insurance company still deny the claim on other grounds not listed in the initial denial/appeal? Example: The insurance company denies the Lap-Band due to "investigational" reasons only (no other reasons listed) and the External Appeals Board decides it is not investigational and overturns their denial. Can the insurance company now deny the claim due to medical necessity or do they have to pay the claim with no other questions asked? Can the insurance company request additional medical records etc. once the denial has been overturned by the External Review Board? Thanks for any information you can give. Lisa

I'm not Gary, but I know the answer. The insurance company is required to enumerate all the reasons your claim is denied in the first denial letter. Then they have to tell you how to appeal, and what information/documentation is needed to "perfect" your claim. They can't keep coming up with new and interesting ways to torture you. That being said, don't think they won't try it, or anything else if they think they can get away with it. Remember, they want you to slink off with your tail between your morbidly obese legs, never to be heard from again. Don't let this happen to you. Fight the good fight! Roberta

I'm not Gary but I play one on TV

What a silly, silly man. (Gotta love him.)

Roberta, Thank you so much for the information! I'm still waiting to hear from the external review board so wish me luck. Lisa

Thanks. Roberta is right, and we wish you the best of luck. Give them hell.