insurance denial

I just went thru everything  that I thought I needed to  to get Peia to pay for my surgery, I have a bicuspid valve that is getting worse and I am going to have to have a valve replacement in the near future. I even had my cardioligist send a statement to the insurance company and I was still denied. I went thru a weight management program for 10 months and injured my knees, my surgery is scheduled for 4/28/11 and now I am denied.  I cried for ever when I heard.  I have an awsome Dr. he was at Ruby and now he is in Preston Co.  If anyone has any information for me that might help me get approved   PLEASE HELP!!!!

What specifically did they deny you for? 

They said I didn't have a statement from the  Dr. stating why I would benefit from this surgery and they wanted to know how long my pcp has been my pcp.  I completed 10 months of weight management thru peia and had to discontinue because of some problems that developed with my knees.  I swear whoever makes these decisions must only weigh 90 lbs.

We'll the good news is that they seem to have denied you on lack of paperwork.  It hopefully will be very easy for your Surgeon and PCP to put together a list of benefits for the surgery.  The more co-morbidies that you can list the better, sleep apnea? diabetes?  etc? 

I really think that the insurance companies deliberately try to make it harder so that SOME people get fed up and throw in the towel.  Let's face it, their vested interested is SAVING money for THEIR company.  Give 'em the good fight and you will most likely end up as the winner.  Best of luck to you.

thank you! I just want this done NOW I can't wait to feel better

Looks like this denial is rather easily overcome actually.  Find out exactly what you need and have your doctors get it together for you.  Stay on them. 

You've come too far so just push on through as you're almost there.  This is just a setback, it's not something that cannot be overcome. 

Your "golden egg" is right in front of you! Those knees will soon need replacing AT A HUGE COST and long rehab. DO YOUR HOMEWORK!
Best of luck!

Just get them the info they want, it's all a big game and you just have to play the way they want you to. I was denied 3 times before getting OK'd for the same reason, wanted more paperwork. Yours sounds like an easy fix. Good luck to you!

Thank you for the words of encouragement!  Hope all goes well with you.  I just really want to get this done so I can feel better.