GARY PLEASE HELP.

sexysweetsweet69
on 7/3/05 6:42 am - Milwaukee, WI
I mailed the insurance commissioner an appeal , I worked on this appeal for 5 months. I questioned the fact that I had emails from the hr dept saying that our insurance policy hasn't change in 7 years from 1998-present. I was going through some paper work, I found a packet unopened , but when I opened it it was a certificate of coverage dated 2/2003, that had a different exclusion from the one that my company said I was under. That exclusion stated, will only cover wls if morbid obese. I know that my company recently went through a chapter 11 bankrpy I don't know if plan changed and they just didn't inform the employees. I also question the exclusion they said I was under, any treatment to reduce obesity but not limited to surgerical proceedures. Since my bmi is 72 my diagnosis is not obesity Its super super morbid obese. So I sent in both exclusions and also the nih info on morbid obesity , I also sent in my insurance company's crtieria for wls. Which I meet both.2 off my doctors sent in letters of medical necessity, my pcp said the it is medically necessary for wlso for my comorbidites he didn't focus on weight. My polmnary doctor , advise that I was on cpap but not working still sleepy and waking up with severe headache. I also sent in cosy of members with same insurance 123 member who were approved only policy must be medically necessary, I also stated that most bmi was small with the same comorbities, some even had same exclusion and was still approved.I Sent in wls attempts , medical histry from the last 20 years. This is what they had to say. They letter states that they review Humana's response and the information you provided up carefully , although I understand and appreciate the frustration that causes you to contact us I am unable to resolve your complaint to you satisfaction based on the information provided it appears the insurance company did not violate an insurance law or regulation with respect to the issueS raised in your complaint. Our office has limited authority to resolve complaints when there has been no apparent violations of the Wisconsin insurance laws. Based on the information , we were unable to resolve your complaint to your satisfaction it is important our determination is based on complete information if you have addition information to support your position which has not been reviewed by this office and you feel your complaint warrant father review please send additional information. This a sad excuse for denial, I don't see what they reviewd, none of my questions were answered. I asked 10 questions to be answered . No one has answered my questions. My job is self funded under erisa is this the reason. Can you help me , this was the 3rd denial I have recieved. I feel like I am being discriminated against. My supervisor, HaD bunyon surgery, not once but twice , my doctor told humana that I have edema really bad and that wls will cure it , My other coworker just had knee surgery , my doctor told humana that I have arthirits in knees back problems but I have to go through a years with them telling me no. Some one else at work just had back sugery, WITH NO PROBLEMS.This is not fair. Can you help please , i CAN'T STOP CRYING.
gary viscio
on 7/5/05 3:45 am - Oceanside, NY
RNY on 07/01/03 with
Please email me privately for legal advice and we'll talk.
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