Ins Question: Harvard Pilgrim

It's official, my insurance won't cover WLS. When I asked about appealing the denial, the director of Benefits told me, "Even if your doctor said you'd die without it, we won't cover it". Lovely, isn't it? The plan is self funded, so they can do what they want. I'm looking at purchasing non-group coverage through Harvard Pilgrim and I have a few questions. 1. Has anyone had any problems with Harvard Pilgrim? 2. Has anyone done WLS through the non-group plan? 3. Does anyone know if you can have Harvard Pilgrim as non-group while maintaining your group coverage through your employer? I ask this because I have my husband and son on my insurance; if I drop my employer's insurance I'll have to get non-group for all of us and it's very expensive (my husband is a stay at home dad, so it's not an option to pick up insurance through his work). I thought I'd ask here before I go to the insurance board in hopes that someone might have Harvard Pilgrim insurance and have some advice to offer. I've had to put off my initial appointment until the end of May now; Newton Wellesley won't even see you if you're self pay. This is frustrating! Ann

Hi Ann I hate to say it but Harvard Pilgrim approved me within 7 days after the paper work was submitted. Actually the drs office called me with the approval and the next day I recieved the letter of approval. They even called me about 3 or 4 days after I got home from the hospital and asked how I was and how the surgery went. I am really perplexed at why they denied you. Did you inquire the reason? My friend had been denied and appealed and now she is 3 months out and losing weight everyday. You should appeal. Good Luck Stephanie

Hi Ann, Is it HP that will deny you or does your employer have a specific exclusion for WLS? I have HP and was approved within days. But if your employer has a statement in their policy excluding the surgery, then HP won't approve it. Kerry

I cobra'd mine after leaving my last job and am forever grateful.. I was approved in less than 24 hours.. Harvard Pilgrim is the best insurance I have ever had.. wonderful organization to work with April

We have Harvard Pilgrim through my husband's work and they've always been great. They approved me in less that 24 hours and I'm a light-weight (my BMI was just over 40) without co-morbidities. Dr Gazmuri's office didn't even bother to submit my paperwork to HP until after they had scheduled me because HP's always been so good. Good Luck, Carolyn PS you might be able to get some answers about having dual coverage from Dr Gaz's office at NW. They deal with the insurance companies enough.