Denied

Hi all, I just came home and there was a message on my answering machine from Dr Tersigni's office saying that both insurances had denied my pre auth for WLS and asked if I wanted to self pay. Doesn't sound like they are going to be very helpful. What exactly should I include in an appeal? I was surprised at my visit that the doctor's office really didn't want much info about my problems when they sent it off. I really am not very hopeful that they will change their minds, my primary Insurance Co is actually owned by my employer. Does anyone know of any employers in the Roseburg area besides Mercy and Ingram that will cover WLS? Thanks. Amy

Amy - I'm so sorry to hear of your denial! I thought Providence paid....that's awful! I know that Federal BCBS still pays, so if you were with the forest svc or post office it might help. I don't know about other agencies thoug. I'm pretty sure I've heard Aetna and Cigna mentioned a lot by people who have had coverage but I don't know where to find them. If you find you can't manage with insurance, if you can afford a little out of pocket ($8500), I could give you the info on the doctor I saw in Mexico. I'm a huge chicken, but this experience was very positive for me and I have nothing but good things to say. Good luck! Dina

Hi Amy, DON"T GIVE UP!! First thing to do is get the denial letters or call your insurers and find out the basis for the denial. They have to give you reasons and the denial letter usually spells it out. It could be something simple like not enough information to fully assess your request, or it could be lack of co-morbidities. Insurance companies won't do the work for you, they'll just deny you. It sounds like they didn't have enough documentation from your pcp. My employer is self insured as well and I was denied, but I fought it for a year and finally was approved. Had the surgery April 19th and doing really well. It's worth it. Don't private pay until you've exhausted all your options. Read your insurance policy from work thoroughly and fight! I'm happy to talk to you if you'd like. Just email me. Chari