Question:
Pacificare HMO let me have the consultation with the surgeon and then denied Surgery

And today I recieved the denial letter from the appeal. What do I do now? Do I have any chance with another appeal or do I just give up! Pacificare does pay for wls. Thank You for any advice!    — robin H. (posted on September 15, 2000)

September 15, 2000
SOOO Sorry. I know this is a hard time for you. Please do not give up. In order to help you specifics are needed. Why were you denied in the first place? What does your policy say? EXACT language is needed here, and I do mean the exact policy provisions. Then what was the reason for the denial of the appeal? Last is to see how your individual circumstances relate to this policy and how to present yourself and your comorbids to them. Best of luck.
   — JennyLynn A.

September 15, 2000
I too have Pacificare HMO but in Washington. I am still awaiting response from them to see the surgeon. My suggestion to you is find out why the denial. Could be something simple missing from your chart. Find out what there criteria is so you can make sure you match. Here in Washington Pacificare requires you to be atleast 100 lbs obese for a minimum of 5 years, been on a medically supervised diet for 6 months and have atleast 2 morbidities. Forgive me if you already know all this. Good luck. Cynthia
   — Cynthia L.