Question:
WOULD IT HELP OR HINDER CONTACTING DEPT. OF INS.?
I'm trying to decide if it would help or hinder my chances at insurance approval if I send a carbon copy of my appeal letter to the Dept of Ins.? I have been denied and on my second appeal. — [Anonymous] (posted on August 30, 1999)
August 31, 1999
It will absolutely HELP!! I work for an HMO, so I know what I'm talking
about, I promise. Send a copy to the Department of Insurance, to HCFA, to
your state reprentatives (Congress, Senators, etc.), and send copies to the
MEDIA. MAKE A BIIIIIIIG STINK!!! File a grievance for every slight, real
or imagined, and send copies of those to the Dept. of Insurance, too.
Remember - the squeaky wheel gets the grease! The more noise you make, at
different levels, the better your chances are of being heard and approved.
Use words like "bad faith", "eggregious",
"misleading", "unprofessional", "inhumane",
"not in keeping with current medical standards", etc. Also file
a complaint directly with the Dept. of Insurance. And when you send copies
to your Congressperson and Senator, ask them to assist you and intervene on
your behalf. That's why they're there! Good luck, and feel free to e-mail
me directly if you need help.
— Kim H.
August 31, 1999
ABSOLUTELY contact the Insurance Dept. In my case, my insurance company
had been telling me since February that I was covered, and that since I had
to go out of state for the surgery, that it was merely a matter of
appealing In-Network vs Out-of-Network level of payment. (They'd approved
out-of-network). I was in the process of appealing for in network coverage
as there is no one locally qualified to have done my surgery. 2 days before
I was due to leave for my surgery, I got a fax that said, "...we're
sorry for the inconvenience but, we made a mistake this isn't covered at
all!" I wrote a grievance letter that nite, and the next morning
copied the Insurance Company, the Insurance Commissioner, and my attorney,
and told them they had till close of business that day to reverse their
decision or be faced with a law suit. I had very well documented
conversations, dates, times and names of people who'd told me it was
covered. At 4pm that day, I received a phone call
and a letter was faxed to me and my surgeon and hospital that they were
covering it in-network. I'm sure my situation is different than your's.
It turned out my policy very specifically excludes EVERY type of WLS. But
5 different employees at my insurance company, including the medical
reviewer, told me it was not excluded and was covered and had already been
pre-certified. If you don't have a specific exclusion for the wls you're
having, document everything and copy your insurance commissioner. Best of
luck!!
— Sherrie G.
August 31, 1999
I am not sure who the governing body is in most states. I can tell you
here in California it is the Department of Corporations who is the watch
dog on insurance companies and is whom one would contact if not satisfied
with the out come of appeals process with the insurance company.
So if in your state it is the Dept. of Insurances then I would go for it.
I send you light and love.
Jeannette
— Jeannette C.
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