Donna W.

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tnpeterscci 19 years, 1 month ago

Donna, NO! NO! NO! Don’t Give Up! That's what the "BIG BAD INSURANCE COMPANY" wants you to do, So that they don't have to pay for the cost of it!!!!! I have to appeal an exclusion in my employers’ policy with United Healthcare and I’m on my second appeal. I asked my employer to over-turn the exclusion and they told me NO! And so I know how you feel sometimes so don't feel alone that's why we're here is to help others. So, I have a friend that had to go through the SAME THING WITH AETNA that you're going to need to do. It took her 2 insurance companies (Humana & Aetna) & over 2 ½ years to get approved, but she and had surgery on July 19, 2004 by doing this Ok! She has lost right at 100 lbs.; here is what she had to do: #1 File an appeal on this denial. Yes, I’m saying on the first denial! If and when they deny this appeal in which they will! And I'm not trying to discourage you in any way, because I also feel your pain with what I am going through also. I have good and bad days to. #2 File the second appeal, and there going to deny you again. Ok! There reason is going to be that it’s an exclusion in your employers’ policy. But fight them to the end. Hopefully you want have to go through all of this but in case you do here is how she was approved. #3 After the second denial you have the right to send your claim to an independent revue board. That has nothing to do with the insurance company at all. The independent revue is where they take a look at your case to decide whether or not you need the procedure. If they feel you in fact do need it they can and will make the insurance company pay for the cost of surgery. The only thing that my friend had to pay out of pocket was her deducible for the hospital stay. I hope this can and will help you get approved for the WLS. If you have any questions please! feel free to contact me @ [email protected]. Thanks, Tania N. Peters

princesssplenda 19 years, 4 months ago

Just dropping in to say hello! I hope you enjoy this website as much as I have. You'll find all the support and knowledge you need right here. Hugs from my heart! Candy RNY 11/16/04