Question:
appeal
They say it can take up to 30 days it's been 20 and I am going crazy — araynard29 (posted on March 22, 2010)
March 22, 2010
Well, I didn't have to appeal, but I had to wait one year to have my
surgery approved with going to my Dr once a month throughout that year.
— FSUMom
March 23, 2010
As long as your policy does not state weight loss surgery (exclusion), no
matter what you do they will not cover,if it does not state this,you should
be covered,just do everything they ask for!
— rebecca W.
March 23, 2010
Your OH Profile is not filled in so we don't know your entire story. What
Insurance Company are you using? What types of Weight Loss Surgery are
covered by this company? Is this an Insurance Company managing your
Medicare (if your on Medicare)? If through Work, there may be that
Exclusion. What type of WLS are you seeking? Please fill in the OH
Profile?
In your Appeal, who wrote your Appeal Letter(s). At the lease YOU, Your
Primary Doctor and maybe one from your surgeon's office. Amongst others too
should be included like from church, Nutritionist, Personal Trainer or
Health Club, etc. The Insurance companies have 30 to 60 days to respond -
it's in their handbook. But your States Insurance Commission will have
those answers too. Good Luck.
— Michael Eak
March 23, 2010
You can always call your insurance company to ask if your documentation has
been received. You're not ready for an appeal until you've received a
denial in writing from the insurance company. Appeals are answered
specifically to what the denial states as the reason for not covering the
surgery. So for now, call them; 30 days is the common waiting time for most
insurance plans. You can ask them that question too when you call. Good
luck and try to be patient a little longer if they don't have an answer for
you when you call.
— Arkin10
March 23, 2010
I started in 2005 trying to get the surgery, I have HAP and they said I had
to go 1 year attending a medically supervised weight loss structure. I
attended 8 months of one connected to the hospital. I didn't like the food
and it was extremely expensive, I quit. In 2008 I joined Weight Watchers,
Hap paid for it. When I applied again, I was denied because they said
Weight Watchers was not considered a medically supervised weight loss
program. I appealed, and got another denial letter, saying the same thing.
I appealed again (the next step would be to appear in front of a medical
board), stating the same as in my first appeal and also reminding them that
I had done 8 months with their weight loss program. I was okay'd and had
my surgery on March 15. I am so happy that I stuck to it and did not give
up.
— jams951
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