Question:
HAS ANYONE SUCCESSFULLY OVERTURNED AN APPEAL??

I HAVE SELF-FUNDED HEALTH INS. THEY HAVE DENIED ME TWICE. HAS ANYONE BEEN THRU THIS? ANY SUGGESTIONS?    — LISA Q. (posted on June 6, 2003)

June 6, 2003
Why are you being denied? Is it a policy exclusion? Or are they stating it's not medically necessary? Perhaps you have not demonstrated failed attempts? Or maybe you don't have a history of medically supervised diets for X period of time? Your question's very vague and difficult to answer without more detail. If you can provide more information I'm sure someone will be able to assist. =) In general though, insurance denials are not hard to have overturned, you just need to provide the right pieces of missing information or compelling information.
   — Kimberly J.

June 6, 2003
I recommend you check out the government's website on insurance regulators for each state. I'm not sure of the policy on self-funded, but it's worth checking out. I'm currently in the process of complaining about poor service/stall tactics from United Healthcare PPO (regarding reconstructive plastic surgeries). The State of Illinois Office of Consumer Health Insurance was very helpful when I called them. Here's the link http://www.pueblo.gsa.gov/crh/insurance.htm Each state is listed. Good Luck! - Anna
   — Anna L.

June 6, 2003
Hiya, had the same issue. Contact your benefits administrator they can push it through. Hope you are a loser soon.
   — trijnity

June 6, 2003
I appealed twice and both times I was denied. I only had one appeal left and whatever the answer was would be final. I spent my income tax return and hired Walter Lindstrom. It was the best $800 dollars I ever spent. He won my appeal and I am scheduled for my consult with my surgeon in 10 days. Insurance is going to pay 100% of the inpatient costs. Walter does have a one time only appeal that he charges $450. Either way, he knows what to say. He's had bariatric surgery himself.
   — Elizabeth B.

June 6, 2003
I work for a self-funded insurance company. It really depends on hy you were denied. if there is an exclusion, there may not be lot you can do. Let, me say, too, that if your company has a three step appeal process, you are very lucky. Ours only has two. If you are denied the second time, that is it! E-mail me if you want and maybe I can help. My husband was initially denied for WLS (no exclusion, but he didn't meet criteria). We appealed and the denial was reversed, and the criteria was also changed!
   — koogy