Question:
What am I going to do? Insurance says it's not a medical necessity.

----- Original Message ----- From: Colleen Kubat <[email protected]> : Deniel again I have this problem with Care Choices. Well I filed the certification for consultation my PCP sent in was denied. So, I filed a grievence that was denied because my doctor (who is not for it) wrote that all I had was High Blood Pressure and Diabetes, both were under control. Then I filed for an appeal in front of the Reconsideration Board that also was denied. They did say that there was a small problem from the first letter that my doctor wrote. To the one for the second hearing that did contain more information that was correct this time. They were very impressed by all the medical records that I had collected on my own as they weren't supplied any by who ever was suppose to collect it all. They said that I seem to have a good knowledge of the WLS. They asked questions. Then the Medical Director had her say all she would say was it was not a covered benefit. I already remember her from being my mother's doctor while she was still practicing medicine and my mother was still alive. The Med. Director and my PCP use to be in practice together. So I was denied again. Now I have contacted the HMO Task Force. Any help as what to expect. Also when open enrollment come around we will be changing to one of the other General Motors Insurance Plan any help there. Colleen    — Colleen K. (posted on July 19, 2000)

July 19, 2000
I had to fire my first pcp. My second was not really supportive. I was denied 3 times because they said it was not medically necessary. I then had my gyn, sleep apnea dr.,surgeon, any dr. that I had seen to write a letter on my behalf. I also searched on this site for any other people that had the same insurance & that were approved. I then wrote a very nice letter NAMING the people that were approved and I asked this question. How can you approve so & so and NOT approve me when 4 doctors say it is medically necessary? I was approved! It was a long hard fight. But it was a turning point in my life. I am so thankful. I hope this may help you too!
   — Janice K.

July 20, 2000
Colleen: I have a link on my website on Insurance Tips. This link is loaded with tips on getting approval. Check it out. http://www.geocities.com/mrsverlin/index.html
   — Cindy H.