Question:
HELP!! Anyone have input for overturn of denial.....

Was told in March of 05 that I had to swith from my company's Humana PPO to HMO to have surgery covered. Waited for open enrollment and new policy went into effect Jan 1, 06 (company's open enrollment was changing, so this was a 6 month policy). Started my 6 month physician supervised diet in Jan, as soon as policy went into effect and ended that 6 month supervised diet June 21st. New policy went into effect July 1st and now there is an exclusion. How can they require a 6 month diet if, at the end of the 6 months, I don't even have the chance to be considered?!? Any help? Any suggestions? Anyone beat this type of situation?    — Trish M. (posted on July 16, 2006)

July 15, 2006
Addendum: Anyone with any suggestions to offer please contact me at [email protected]. I'd appreciate anything anyone has to offer. Thanks!
   — Trish M.

July 16, 2006
http://www.obesity.org/subs/disability/ The old insurance game will drive you nuts. I'm fighting it myself. I don't know if the above sight will help but it does make you aware. We are looking to change in January and I am going back to my diettician this month so that when we change in January I have that covered, but the IF is will the new insurance cover?
   — sandra J.

July 16, 2006
If you began the diet while under the old policy guidelines, and had already asked about the sutrgery, you should be "grandfathered" in. The rules in effect when you began should cover you. good luck!
   — Novashannon

July 17, 2006
You can always appeal a denial. Most insurance plans have a caveat somewhere that they can change the benefits whenever, without notification. You are your own best advocate. I would call your customer service line and find out who you need to send the letter to, and get it done. Just state the facts as you did above, in a matter of fact manner. Above all don't let your letter get whiney and emotional, as that really turns the people reading it OFF, big time. Good luck!
   — koogy