Question:
WOULD IT HELP OR HINDER CONTACTING DEPT. OF INS.?

I'm trying to decide if it would help or hinder my chances at insurance approval if I send a carbon copy of my appeal letter to the Dept of Ins.? I have been denied and on my second appeal.    — [Anonymous] (posted on August 30, 1999)

August 31, 1999
It will absolutely HELP!! I work for an HMO, so I know what I'm talking about, I promise. Send a copy to the Department of Insurance, to HCFA, to your state reprentatives (Congress, Senators, etc.), and send copies to the MEDIA. MAKE A BIIIIIIIG STINK!!! File a grievance for every slight, real or imagined, and send copies of those to the Dept. of Insurance, too. Remember - the squeaky wheel gets the grease! The more noise you make, at different levels, the better your chances are of being heard and approved. Use words like "bad faith", "eggregious", "misleading", "unprofessional", "inhumane", "not in keeping with current medical standards", etc. Also file a complaint directly with the Dept. of Insurance. And when you send copies to your Congressperson and Senator, ask them to assist you and intervene on your behalf. That's why they're there! Good luck, and feel free to e-mail me directly if you need help.
   — Kim H.

August 31, 1999
ABSOLUTELY contact the Insurance Dept. In my case, my insurance company had been telling me since February that I was covered, and that since I had to go out of state for the surgery, that it was merely a matter of appealing In-Network vs Out-of-Network level of payment. (They'd approved out-of-network). I was in the process of appealing for in network coverage as there is no one locally qualified to have done my surgery. 2 days before I was due to leave for my surgery, I got a fax that said, "...we're sorry for the inconvenience but, we made a mistake this isn't covered at all!" I wrote a grievance letter that nite, and the next morning copied the Insurance Company, the Insurance Commissioner, and my attorney, and told them they had till close of business that day to reverse their decision or be faced with a law suit. I had very well documented conversations, dates, times and names of people who'd told me it was covered. At 4pm that day, I received a phone call and a letter was faxed to me and my surgeon and hospital that they were covering it in-network. I'm sure my situation is different than your's. It turned out my policy very specifically excludes EVERY type of WLS. But 5 different employees at my insurance company, including the medical reviewer, told me it was not excluded and was covered and had already been pre-certified. If you don't have a specific exclusion for the wls you're having, document everything and copy your insurance commissioner. Best of luck!!
   — Sherrie G.

August 31, 1999
I am not sure who the governing body is in most states. I can tell you here in California it is the Department of Corporations who is the watch dog on insurance companies and is whom one would contact if not satisfied with the out come of appeals process with the insurance company. So if in your state it is the Dept. of Insurances then I would go for it. I send you light and love. Jeannette
   — Jeannette C.