Urgent Question for Mr. Viscio

Thank you for your response to my previous questions. I was wondering if you could answer one more for me. I just got word that GHP has denied me again, though I haven't got the letter yet and don't know the reason and they couldn't seem to tell me. I am seriously looking into filing a complaint with Dept of Insurance and am researching the statutes/regulations on this. I am finding that this process seems to fit more into "utilization review", under "prospective review" rather than regular appeals. If that is correct, Missouri law seems to stipulate that they have to render their decision in 2 days and telephone the provider within 24 hours, none of which they have done. Do you know if I am making a correct assumption that this is actually the law that should apply rather than the policy's appeals section, which gives them so much time? Thanks for your opinion.

You call that insurance company back and DEMAND that they tell you why they turned you down. They should be able to pull it up on the screen and read that letter to you. I used to let BCBS push me around until I was informed by my Lawyer's office (Gary) that they are MY insurance company and they have NO right holding any information back from you. They refuse to give me any information until they where reminded that this is Donna Chu's appeal and as such you should not hold any information back on her appeal. They started talking Donna

Donna, Thanks for the support, I would have done that, but was told the letter would be immediately forthcoming and I got it yesterday afternoon. They apparently ignored the 25-30 pages of studies and documentation that proves that lap banding is NOT experimental and are standing by their denial as "experimental". I will probably make an immediate appeal to the Department of Insurance and see if they can force them to provide the surgery for next year, as I think it is very plain they are just stalling so that my time expires. I don't plan to go away as easily as they would like me to! Thank you again.

Good for you!! stand your ground and don't take any bull from these people Donna

Please email me with questions, due to confidentiality I can't answer specific questions publicly.