Question:
I was recently denied by Kaiser, Was told I did not meet the criteria. Help!

I just found out today the true reason why I was denied by Kaiser. I was told that I did not meet the criteria. Amenorrhea is not considered a co-morb. My question is will this affect the appeal. I mean, Will they deny me again? I am really in need of some help! God Bless!    — AliciasMommy (posted on April 9, 2002)

April 9, 2002
Appeal! Appeal! Appeal! As for co-morbids- hows your BP? Are you seeing JUST a PCP for your Ammenorreah? Do you have any other symptoms, symptoms that you may feel are just wierd?
   — Karen R.

April 9, 2002
Hi there. I just saw that you were diagnosed w/ stress urinary incontinence also. That one is DEFINATELY a co-morbidity. Even so, you're over 40 BMI. Keep appealing that stupid company, grrlie!
   — Dana R.

April 9, 2002
Is your amenorrhea part of another condition? PCO (Polycystic Ovarian Syndrome)perhaps? Which Kaiser? I am with Kaiser as well and the process was pretty easy (minimal hoops to jump through) I have PCO, stress incontinence, high cholesterol, etc. Appeal. There are many doctors in the Kaiser arena that do support this surgery.
   — Rhonda P.

April 9, 2002
Have they told you exactly what their criteria are? It's kind of hard to appeal when you don't know for sure what you are appealing. You absolutely have the right to get that information. If they don't want to give it up, call your state's Insurance Department and ask about it.
   — garw

April 9, 2002
Oops, forgot to say that you should get it in writing. NEVER rely on what any insurance company tells you over the phone.
   — garw

April 9, 2002
Hi: Call Kaiser and demand that they fax or mail you their specific criteria...you are entitled to have it...you're paying for their services...I had to do this, because my medical group kept trying to "buffalo" me as to what their criteria was....Finally I had the criteria in writing and nobody could try and get one past me any longer....Good Luck and DO NOT GIVE UP...THAT'S WHAT THEY WANT YOU TO DO...GET PASSIVE AGRESSIVE WHEN IT COMES TO YOUR HEALTHCARE...God knows your HMO is not looking out for your best interest....
   — Joi G.

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