Denied by GHI becaue of age!!

Jonathan L.
on 8/20/04 10:47 am - Bronx, NY
I was denied only because I was 17, although prior to sending out my first request letter I called GHI and was told the age was not a problem. Also, when I recieved my first denial it said the patient had to be 18 OR have documented skeletal maturity. I have the skeletal maturity documented but still they denied me. I'm in the process of trying to get information on how I would go about taking legal action. I found out the day before my surgery that I was denied. First they tell me age is not a problem if I have the bone age and skeletal maturity tests which I do have. Once they recieved that they said that it was still denied. This is not fair, they gave me false information and It hurts so much that after the two years I went through to get to have my surgery, they denied me and gave me all this false info or LIES like I like to call it. Now I sit here the day of my surgery and I have to deal with this, it hurts so much. If any one esle has experienced problems because of age please reply and let me know how they dealt with it. Thank You - Jonathan Lebron
Roberta A.
on 8/21/04 2:50 pm - Marietta, GA
Jonathon, First, it really upsets me when I hear that people like you are given a surgery date before they get an insurance approval. It is so unfair of your surgeon to get your hopes up that way. Insurance approvals can take months, or even years. It sounds to me that the insurance company didn't bother to read the documentation you submitted. Is your coverage through your parents? If so, they need to write an appeal letter to the insurance company, pointing out that fact that the necessary documentation of skelatal maturity exists, and include it (Again) with the appeal. Your denial letter will tell you where to send the appeal. Get right on it, because you may have a time limit. Hang tough, and keep at them until you hear "APPROVED."
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