Question:
2nd level appeal what next ins. comp. says this is final decsion?

   — Elizabeth R. (posted on April 27, 2003)

April 27, 2003
I am sorry to hear about your insurance trouble. Did they state the reason for denial? Is it written in their policy as an exclusion? If not, I would take it a step further and have a local attorney send them a letter on your behalf, along with your doctor's recommendations, co-morbitities, etc. YOU pay premiums for your coverage... YOU never miss a payment for that coverage. In my opinion, they are acting in bad faith ("bad faith" is a word insurance carriers do not like to be threatened with). Have your attorney state that you will be contacting the state insurance commissioner if they refuse you this life saving procedure. Without all the details, I'm just throwing ideas out at you, but hopefully some of this will help. I have worked for a doctor's office for 10 years and have been dealing with insurance all that time. I'm use to fighting denials for other people. You want to try the nice approach, but they are clearly not upholding their end of your contract.
   — Happy I.

April 27, 2003
Run out and get yourself a copy of the current (May 2003) issue of Reader's Digest. There is an article in there about Getting your health insurers to pay up...good info on the appeals process. Also, here's a link I found a couple of weeks ago that gives info on insurance regulators in all 50 states: http://www.pueblo.gsa.gov/crh/insurance.htm Find the insurance commissioner for your state and contact them if necessary! Good Luck- Anna LAP RNY 7/3/02 -123lbs.
   — Anna L.