Question:
Has anyone had an approval from Albersons First Health. I am waiting for approval.

   — Mary L. (posted on December 4, 2000)

December 5, 2000
Well, I haven't had experience getting this surgery approved, but I worked at First Health for 14 years and am very familiar with the Albertson's plan. This surgery has been approved in the past, but you are going to need your doctor to be very extensive and specific in his pre-authorization. I don't know how far you have gone in your request, so I'll start from the beginning. Your doctor will need to list all your medical conditions, state your previous attempts at weight loss and what he feels will occur if you do not have this surgery. If you have sleep apnea, have your doctor document it. If you have a heart condition, document it. If you have hypertension, document it. Do not go on about anything that is not related to the medical reasons for the surgery. Do not under any circumstances discuss how being overweight has affected your life. Stick strictly with the medical reasons. If you are initially denied, appeal. First Health is not an insurance company, but a third party administrator. They are not bound by federal insurance laws. They fall under ERISA, which means you have the right to appeal any denial. One thing, the law is changing, but currently you only have 30 days to appeal a denial. If you are past the 30 days, you cannot appeal. If you are appealing a denial, ask specifically that your appeal goes to the Plan Administrator to review. Albertsons is the Plan Administrator and they have a medical consultant on salary that meets with the Albertsons Benefits Director and First Health twice a month to review pre-authorizations. I hope I have helped you. Good luck.
   — [Anonymous]