question about insurance commissioner.

sexysweetsweet69
on 5/29/05 12:39 am - Milwaukee, WI
hi family I have a question I was denied wls due to an exclusion, 7/2004, any treatment to reduce obesity, but no limited to sugerical procedures. So after I was denied the first time , i appealed 11/2004 , then had a grivance meeting 12/30/04 . denied again. So I was advsd by Humana that I would have to appeal to insurance commissioner did that, 5/17/05 they told me I had to wait for 4 to 6 week for the results. If my emplyer is self funded erisa . What happens , can the insurance commissioner still approve. I asked my Hr what does erisa mean she sent me the definition but I just really didn't understand. I have a really good appeal. I am fighting them with , super morbid my bmi is 70.5 and also I have 2 different certificates of coverage. with different exclusions. I also have emails were my hr dept told me that the plan that I am currently under hasn't change in 8 years . I have 2 plans with differnt date that say other wise. So I am fight on that 2 . I am fighting also instead of super morbid obesity but my co morbities . Can the insurance commissioner do anything?
Scarlet *.
on 5/30/05 1:35 am - Ft. Wayne, IN
Sherry, it sounds like you have some really good ammo. Thats where insurance companys slip up. They try to confuse you by being unclear, but you can use that to your advantage. The best of luck to you, I will say a prayer for your approval.
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