Question:
Denied again. 3rd time. Considering Self-Pay. Need Suggestions.

I've pretty much given up on getting approval from my insurance company at this point. Just received a letter from them for the 3rd time denying me. My medical records are not complete thanks to my former Doctor and I've been fighting and fighting this since July 2002. Aenta (my ins. co.) now tells me that no further review is available. Can someone recommend a company that I can go through to get a patient loan? Thanks for your help, Pamela.    — pamela1 (posted on January 14, 2003)

January 14, 2003
Atena may have told you that there are no other reviews...but did you know Does Texas require an external or independent grievance system to appeal your health plan's unfavorable decisions? Yes, for all health plans. On what grounds can you file your external grievance? Medical necessity. What is the status of the external grievance panel's decision? Binding. External grievance systems allow you to take a dispute with your health plan to a doctor or review board unaffiliated with your health plan. Thus, both you and your health plan receive an impartial ruling on its decision to deny coverage of services or treatment. Additionally, you can file a complaint against your health insurer with your state's department of insurance. You may want to check this site http://www.insure.com/health/ http://www.insure.com/health/obesity.html
   — Jon S.

January 14, 2003
You might want to consider hiring Walter Lindstrom, the attorney who specializes in getting insurance co's to cover WLS. Check out ObesityLaw.com. It would be less costly to hire him than to self-pay. There are a lot of questions on this site referring to his services. Good luck!
   — Carlita