Question:
Who's been denied by insurance carrier and had to appeal to employer

   — [Anonymous] (posted on August 2, 2001)

August 2, 2001
I'm almost to that stage! The problem is my employer is my insurance company. I work for them. We shall see.
   — Dawn R.

August 2, 2001
I appealed it got me NO WHERE!!!! They do what they want. Hope you have better luck!
   — [Anonymous]

August 2, 2001
That would be me. I was denied by United Health Care PPO I appealed to my employers' benefits office and they overturned the denial and directed United to pay it out of contract. They figured I would win an appeal with legal action anyway and they felt my request was justified so they just went ahead and approved it. The really amazing thing is that even though I no longer work there, I do still have my insurance coverage there -- and they have now done the same thing for me for the plastic surgeries I need. I had the breast lift on May 25 and will have a tummy tuck and inner thigh lift next week. All covered! Amazing. cheers, Ann RNY 9/10/99 260/125
   — [Deactivated Member]

August 3, 2001
I appealed and got nowhere as well. They concentrated on the misconception I was asking for an extension of benefits, since I didn't meet the criteria. In my appeal letter I pointed out to them the criteria was unfair and unreasonable and did not match with current treatment standards. All they could concentrate on was that they thought I was asking them to extend the current benefits to accomodate me. So, they denied on that basis. I thought of trying again, but decided to wait until after my new doctor applies for pre-certification, then I would resubmit if I received another denial.
   — [Anonymous]

August 3, 2001
I was originally denied by my Health insurance (Choice Plus). I received advice from two fellow employees that had been denied to go straight to the Corporate Insurance contact. My company self funds their insurance programs. I called and left her a message and was approved in 24 hours. It never hurts to ask!
   — Denise M.