2nd Denial..and my employer lied

Ok so as most of you may know ive appealed a 2nd time with my insurance company as well as my employer since the exclusion is with my employer.  Ive written my insurance company a letter as well as the directer of HR for my job.  3wks later no response.  Then i hear that the HR rep was makking a walk through, to the companies.  I wrote a letter just in case she wouldnt have time to sit and talk with us.  She supposedly checked in with the insurance company and they were told that my surgery wasnt "lifethreatening"  I bout hit the floor.  What made it so bad was my boss's boss came and told him which i dont even know why cuz he knew nothing about it, and that his boss couldnt even come down and talk to me face to face.  I guess me being 25, type 1 diabetic, and hypertension is not lifethreatening to have this surgery Ive told them the exclusion was not from the insurance company but from the employer.  They lied about calling the insurance company because they would've been told that, and they know that.  I'm so fed up right now i can scream.  I've given everything i can for my job and i love my job but the company is full of crap.  I'm so irritated its not even funny.  If they had actually talked to me and let me say what i had to say that would be one thing.  But they lied and then avoided talking to me about it.   Now here are my options.  I can try to take out a loan to pay for this, or look for another job with equal or greater pay.  They're both easier said than done.  I'd rather get a job elsewhere with a company that dosent lie to me.  Not much else to do  Sorry this is so long im just really really bitter right now and went to the one place where i could be listened to.  

I think before you jump to self-pay or to looking for a new job, once you've had a bit of time to cool down, you should contact HR and ask about the grievance policy. Then, keep notes. Even if it seems inconsequential, keep a log of who, when, what was said, why you called, etc. It sounds like there are many people involved here, and that some lines are getting crossed; it happens when you have a "telephone game" system of passing along information; inevitably, stuff gets misconstrued, misspoken, or completely garbled. I do hope it turns out well for you. Don't give up!!! (by me)

Oh i understand what you're saying.  But trust me i know theyre lying about everything.  You know i emailed the HR lady 15 pages of documents.  3wks later she made her walkthrough, and finally a couple of days later emailed me back.  This is all she wrote  "thank you for taking the time to contact me.  To have your questions answered contact your boss and if it needs to be escalated contact his boss"   so she didnt even answer not one question and didnt have the nerve to talk to me.  And she's the HR.  She's the only one to do HR.   Besides this is a company thats fired perfectly good people just to hire family members.  So i think it may be time to look elsewhere. 

what type of ins do you have?

Unicare 

You should hire an lawyer or get advice at least. You don't want to use all your appeals up I used Gary on this site he was wonderful. I didn't have an exculsion problem they just felt I didn't need the procedure but he appealed and I had my surgery last Aug. It's worth the money you will have to pay more for the surgery. I work in HR and if an employer has an exculsion in there policy with the insurance company the company can change it or make an exception if they want to usaually the person that the head of hR reports to can make that decsion but that's only in the companies I worked for. I would ask a lawyer they can tell you the steps you need to take good luck!!!

I dont know.  I'm just iffy about it.  My HR supposedly checked into it and they said it wasnt lifethreatening.  And im almost sure that if i try to fight the company, i wont be having a job there anymore.  Ive seen it happen to other people that spoke of what they thought and they no longer work there. 

They can not fire you because you asked them for something that's not legal you can sue them they need grounds to fire you they need back up and documentation. All I'm saying is you should get a letter from your DR saying all the conditions you have and that he thinks that this surgery is will help and that the conditions you have are life threatining. You don't have to go in yelling even though something liek this gets you angry you just explain or write a letter explaining you need for this surgery and maybe they will have a change of heart. Worse that happens they say no but at least you made an attempt and I would send it to the person who the head of the HR reports to since they already knwo you want the procedure this will at least  open there eyes to what is going on in there company even if it's the presidant of the company just come across professional try to stay calm and maybe you will see results. You can always ask Gary on this site what is the likelyness of overturning an exculsion. Also if you send the letter and they say no ask them to send you the part in the medical plan where it says it is exculded if they haven't already. Hang in there sometimes you have to fight I did!!!

Hi, In my experience your company doesn't need to be involved in this process at all.  They sponsor an insurance program in which you participate, but they are not pricy to your medical information...that's private and protected by law.  Did your insurance company refer you back to your employer or did your employer reach out to you after you contacted the insurance co?  If I were you I'd try and limit my conversations to the insurance co.   Best of luck to you!

Take it up the chain of command, and yes call a lawyer and get advice.  You may have a good case against them, especially for fraud, or possibly HIPPA violation