Ready to give up.
Hi everyone,
You haven't heard from me for awhile. I finished all the pre-requisites that I was told by my the Bariatric Surgery Center adn Insurance company to complete. I was denied due to a clause that states that I am to have a 3 year physician assisted weight loss on file (instead of the 6 month which I was told about) I put in a good appeal. I appealed the 3 year stating that I have showed more than 3 years of trying using Weigh****chers, TOPS, Diet Centers, etc.. No go. This whole thing has been so upsetting.
First, I was called by an advocate from the insurance company. I found out that the insurance company started my second appeal without any new information. It appeared that somehow, my old information was being used for the second appeal. I told the advocate that I had not sent in anything to start a second appeal so she said she would stop the second appeal process until I was ready to proceed with it. I then found out from my Bariatric Center that the insurance called them and told them I did not wish to proceed with the procedure. That really got my goat. So I called another Advocate and told them that I never asked to stop the appeal but didn't wish to use old materials to start a second appeal. So I wrote a letter stating I wished to proceed with the 2nd appeal and my surgeon would be sending in new information (during this time I found out that my VBG had a staple disruption and this is what was causing my pain and the food was backing up into a pocket above the original staple line. ).
My surgery clinic and I were getting ready to send in this new information and in fact, they sent it the new information yesterday. Today , I get a letter dated Nov. 6th (6 days before the new information was sent to the insurance ) stating my 2nd appeal was denied. I am in tears. I didn't start the 2nd appeal and now they are telling me I don't have a 2nd appeal anymore. I am sure this is due to the terrible mix ups about the appeals.
Tonight, I am ready to give up. I can't take 2 1/2 more years of waiting and going to my doctor and watching my health deteriorate. I can't give up, I know that. I am trying. I was hoping to use the Lindstrom Advocacy Agency to work on my behalf, but I can't afford the fees. What can I do???
Maybe I wrote this to get it out of my system. I don't know. I know I care and will be willing to continue to fight. Please pray for me.
LInda
Take a deep breath and call you advocate back and let them know they started the 2nd appeal before you submitted the new material for that appeal. They can't put and appeal thru without your permission/submission. Let them know it is their mix-up. You may ask if you can do this 2nd appeal, now they have the info as a "face to face"/verbal over the phone. This is how I ended up winning and re-winning every step, buy talking to them and explaining every mix up and issue involved. Don't give up it is worth it. Yes it is an emotional pain in the butt.
BAND REMOVED 9-4-12-fought insurance to get sleeve and won! Sleeved 1/22/13! Five years out and trying to get that last 15 pounds back off.
3 years is just completely ridiculous...you have to be very very careful when you have someone else appeal for you, they can say it was verbal, be very careful. so you just have 2 appeals? no external? what does your subscriber agreement say about the appeals process? have you followed everything? make sure you follow everything exactly, and don't take anyone's word, unless it is written down, when it is written down, double check your subscriber agreement to verify they didn't deny you for the wrong reason. good luck
Insurance policies are regulated typically by the ERISA laws and if you have a state department of insurance or insurance commissioner. I'd call both of them and have them look at you.
My insurance commissioner gets right back and when they contact the insurance companies seem to take notice because they can bar them from doing business in the state.
