2nd appeal process

 I am on my second appeal for a revision.  My employer stated in their appeals process that they must notify me of their decision within 30 days that I send in my appeal. I sent everything in on April 30th which would make today day 30.  I called my corporate HR this am (My insurance is self-funded) and she said they did not have any answers but she would check and get back with me if she heard anything.  Well at 6pm she was nice enought to call me and tell me there was nothing back yet.  Can I notify anyone since they did not comply with their rules?

If you are concerned, I would call the nice Corporate HR lady back and ask about their appeals process and the timeline as outlined in XYZ document.  Ask if there is someone else that you need to address your question to.

Good luck,

Judy

 
A revision from what WLS type to what WLS type?  This can make a difference.  However, they still have to respond in a timely matter.

If they do not, the insurance commissioner is your next step.  Tell us please, what have you done, how did you appeal, how many days exactly has it been?

Hello - Well, it's 30 days from the day they receive it - not the day you mail it.  And believe me, I'm not making excuses for them - I work in health insurance and I'm steaming that you've had to wait this long!  I am so sorry that you are still waiting for your answer - must be frustrating for you.

Not being familiar with the "paper trail" of another insurance company, it's difficult to say what's holding it up.  Do they send 2nd appeals out to a 3rd party? 

If I were you, I'd call the insurance company at the toll-free number on the back of your card.  Ask for a "supervisor". 

When your 2nd appeal (and first as well) was submitted you should have received a letter stating that your appeal was received.  Did you get one?  Again, do call the insurance company yourself if you are able. 

You may (and you should) absolutely report the insurance company if they are out of compliance.  Just be sure you have all the facts first. 

Here's hoping the news is good and your procedure gets approved.

Sandie

 Thanks everyone. Yes it was 30 days as I had faxed and received info and verification that they got it on April 30. Anyway I just heard from my HR today that they denied it again. I am done with them. I have been offered another job and have already looked into their benefits and I should be fine. I have a lap band that I have had constant pain on my side for years. I want to convert to RNY. I should also mention my current insurance has also denied all of my sons therapy for autism. Thank god he has MA. My company is self-insured and can do what they want. I am just done with them.