I was denied over the phone.. I need help!

kreative_kat
on 1/14/07 6:54 am - Virginia Beach, VA
I called my health insurance company a few weeks ago to ask if  the surgery was covered.  She was going on about how it was, and then she said it... I'd have to have worked at my place of employment for 5 years first.  5 years!  I just started there in October.  In 5 years I could weigh twice as much!  Ack.  I'm still trudging forward and have my first consult with the surgeon on January 25.  Does anyone know if this type of denial can be overturned for medical necessity?  I haven't actually applied for coverage yet, so who knows what the future holds.  Maybe I got a stupid person on the phone who didn't know what they were talking about - that would be great!  lol  I am hoping I can get approval anyways, but if I don't is there anything I can do?  HELP!!! 
(deactivated member)
on 1/14/07 8:08 am
Spiritthing
on 1/16/07 10:59 am - Brea, CA
Ask for the SPD, or Summary Plan Description. You should have gotten one when you started employment and signed up for your benefits. It will say if it is covered or an exclusion. If it is covered, even after 5 years of employment, it will let you know the requirements that have to be met after that time. If there are specific requirements (like 5 years of employment) than it is highly unlikely that the HR Dept. will overturn it. They chose the plan. It basically keeps employees from being hired, working 3 months or so, then have surgery.....and then quit!. It is expensive for the employer because if it is a self-finded plan, the employer pays the bill. Good luck!     
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