Question:
I don't want to waste my time fighting the wrong people...

Just got my HMO denial letter today, which I expected (policy exclusion). They sent along the "Appeals Process" paperwork. My question is, do I begin working on that immediately, following their steps OR should I have my husband go to his Human Resources Department (huge company he works for) to see if they are self-insured and maybe they can step in??? I don't want to begin a lengthy appeals process with the insurance company if, ultimately, the choice isn't theirs anyway. Suggestions???    — [Anonymous] (posted on September 26, 2000)

September 26, 2000
There is a member on AMOS named Ray Hooks. You can find him in member search on the main page. He is the resident insurance expert and has answered many questions like this for me. Good luck
   — Meli ..

September 26, 2000
Do the paperwork for the appeals process. It will help you organize you thinking and your approach. Have you husband ask HR if they are self-insured working with a third party benefits administrator. If the answer is "yes," then have him get the name of the person works works with the benefits administrator and prepare a letter of appeal the that indivdual asking that they work with the administrator to approve you "off contract." It is helpful to get the exact wording of the plan document if you are being denied because of policy exclusion. Also, you may need to do some education on the difference between obese and morbidly obese. It is helpful if you can articulate some definite health-related goals that you hope to achieve via the surgery. Finally, DON'T GIVE UP!
   — Nanette T.