Re: about your insurance denial

December 10, 1999

:

Maybe you have already done this, but have you requested a copy of the full

blown insurance plan from your new provider? This is sometimes referred to

as Summary Plan Description or SPD. My understanding is that some times in

the depths of 'the party of the first part' lingo is some wording that might

say " when medically necessary " . They usually do not tell you about this

when you call them. That is why you need to ferret the information out by

yourself. If that is the case then letters and documents from your surgeon

will make this happen. (I don't know what a person would do if the were sick

and disabled trying to battle with these companies.) You may also want to

contact your state's insurance commissioner and find out what your rights

are.

I am giving you this advise, as I myself am receiving the run-around from

Aetna. I have spent that last three weeks trying to get a copy of the SPD

from them. Now they claim they don't have any more and they don't know when

the new ones will be printed. Can you believe the nations largest carrier

and they give you an answer like that. Fortunately my dh's insurance does

cover the surgery but I have to be denied by mine first and also go to a

doctor that participates in both plans.

Good luck to you. You watch, some day we too will be on the other side!

Kathie

from land

Re: a thank you to Amber.

> From: Lolipop32@...

>

> Thank you Amber for telling your story. I have read it and used you for

one

> of my contacts. The sad part about all of this is that I was denied for

the

> surgery. I am now fighting the Insurance company with a grievance appeal.

> My referral did not get processed in a timely fashion and was lost for a

week

> under a bunch of paper work. So, my referral never made it to Kaiser for

> approval before they pulled out of NC. Partners turned me down without

> getting a fax from Debbie. She didn't even get the chance to fax them the

> pre certification letter. We were told no right there on the spot. Like

I

> said, now I am fighting the system that I have a formal complaint and my

> request should be processed as it would have been on the 22 of Nov. Before

> Kaiser pulled out of NC. What a frickin mess. I am so down in the dumps.

> What is so funny I have approved visits to see Dr. R. but no approval for

> the surgery, this just does not make any sense to me, none what so

> ever!!!!!!!

>

> Anyway I am so happy to hear that you are doing well. Keep in touch!!

>

> > This message is from the Mini-Gastric Bypass Mailing List at Onelist.com

> Please visit our web site at http://clos.net

>

December 10, 1999