AARGH... Another Denial

I really thought that I had a chance this time around. I had a few poweful letters from doctors explaining the dire need I have to have gastric by pass to correct my reflux condition. Regence just looks at the exclusion policy and doesn't read anything else. Shouldn't they evaluate each person's needs individually??? I am beginning the 2nd appeal process now and look forward to getting an External Review (which I believe is reviewed by someone outside of Regence). Has anyone had any success with this type of review? Tammy

That sucks. I am so sorry. I don't have any experience with such things, but I wanted to wish you luck and tell you how impressed I am with your determination. I think if they had a talk with you, they would know to give up now. Good luck! Hat

Thank you, Hat. I appreciate your supportive words. By the way, I want you to know how much I enjoy following your journey through your witty posts. Thanks! Tammy

Hi Tammy, Im so sorry to hear about your denial. I have CIGNA and fought them 16 mo before I finally won. It took me 3 denials, hiring an attorney, and finally with the external review I won. I didnt have an exclusion tho, just a bunch of pencil pushing idiots that obviously cant read. Anyway, with every insurance company, the answer is yes, all external reviews are done outside the company. I wish you the best of luck, I pray that your denial be over turned. You seem to be a fighter, so DONT GIVE UP!! Take care.......Amanda