My request was Denied
on 3/16/15 9:26 am - WI
Keep fighting. Did they send you a letter explaining why? Sometimes the denial is because of some stupid, little, protocol that was missed by your surgeon's office. I was denied multiple times. I just kept getting my ducks in a row and filed appeal after appeal. I was told by my surgeon that insurance companies will often deny the first request. I sometimes think they deny surgeries figuring most people will just give up after the denial. Think of how many people just walk away and give up. Insurance companies save lots of money by sending out denials on the first try. Don't give up. Do the research into why you were denied and try to rectify the problem.
That is what worry me when you say per your HMO Contract. That makes me think that your policy does not cover WLS. My insurance I had through my employer has that. My employer had a rider put on our policy that it would not cover WLS. Well I went over to my husbands policy and it is so wonderful. I had to go thru 6 months of supervised diet plan then when they submitted request for surgery it was approved within 2 days.
Im self employed so i had to get the obama insurance Independence Keystone HMO and now i find out they do not cover the surgery. I have to find out if i can change my plan to another provider. I pay out of pocket monthly for my insurance. This is such a hassle for something you pay you really have to put up with all this.