Question:
HAS ANYONE SUCCESSFULLY OVERTURNED AN APPEAL??
I HAVE SELF-FUNDED HEALTH INS. THEY HAVE DENIED ME TWICE. HAS ANYONE BEEN THRU THIS? ANY SUGGESTIONS? — LISA Q. (posted on June 6, 2003)
June 6, 2003
Why are you being denied? Is it a policy exclusion? Or are they stating
it's not medically necessary? Perhaps you have not demonstrated failed
attempts? Or maybe you don't have a history of medically supervised diets
for X period of time? Your question's very vague and difficult to answer
without more detail. If you can provide more information I'm sure someone
will be able to assist. =) In general though, insurance denials are not
hard to have overturned, you just need to provide the right pieces of
missing information or compelling information.
— Kimberly J.
June 6, 2003
I recommend you check out the government's website on insurance regulators
for each state. I'm not sure of the policy on self-funded, but it's worth
checking out. I'm currently in the process of complaining about poor
service/stall tactics from United Healthcare PPO (regarding reconstructive
plastic surgeries). The State of Illinois Office of Consumer Health
Insurance was very helpful when I called them. Here's the link
http://www.pueblo.gsa.gov/crh/insurance.htm Each state is listed. Good
Luck! - Anna
— Anna L.
June 6, 2003
Hiya, had the same issue. Contact your benefits administrator they can push
it through. Hope you are a loser soon.
— trijnity
June 6, 2003
I appealed twice and both times I was denied. I only had one appeal left
and whatever the answer was would be final. I spent my income tax return
and hired Walter Lindstrom. It was the best $800 dollars I ever spent. He
won my appeal and I am scheduled for my consult with my surgeon in 10 days.
Insurance is going to pay 100% of the inpatient costs. Walter does have a
one time only appeal that he charges $450. Either way, he knows what to
say. He's had bariatric surgery himself.
— Elizabeth B.
June 6, 2003
I work for a self-funded insurance company. It really depends on hy you
were denied. if there is an exclusion, there may not be lot you can do.
Let, me say, too, that if your company has a three step appeal process, you
are very lucky. Ours only has two. If you are denied the second time,
that is it! E-mail me if you want and maybe I can help. My husband was
initially denied for WLS (no exclusion, but he didn't meet criteria). We
appealed and the denial was reversed, and the criteria was also changed!
— koogy
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