Re: Denied due to exclusion

[Guest guest]

:

You brought up another misconception about obese people. I have heard that

it is assumed that we are not as bright as others. That we have to prove

our intelligence where a thinner person is assumed to be bright until they

prove otherwise. I find it humorous that she thinks that the dr. or his

office had to give you information for you to be aware. I consider myself

to be of average intelligence and I have been impressed with the amount of

research, sharing of information and other related sites, etc. that are

done by all of you.

It is really frustrating to have someone without a clue making decisions

that affect your life. You are in my prayers.

Darlene

[Guest guest]

, I'm so sorry. Insurance companies can be such beasts, I know, I have

a policy with one. My only choice was to appeal to my employer, since they

can approve procedures that are normally excluded. So my hope is, that my

employer put a crowbar into their back pocket and pull out a chunk of

change. LOL I have no idea what will happen after this, only time will

tell. I'm so sorry. No chance in changing insurance companies?

fg

At 09:40 PM 05/05/2000 -0000, you wrote:

>I am mad and sad, I just sent in my 2nd level appeal to Healthsource.

>I called to verify they had it and they do. The person asked me if

>this was another " Rutledge " appeal and does he tell all his patients

>to appeal. I felt at that point I was doomed no matter what else I

>included with Dr. R's info. She said she already knows what his

>appeal says because he sends the same for everyone.

>

>I told her I was advised that at this level the appeal is supposed to

>be reviewed by a " blind " panel included on the panel is supposed to

>be a specialist in the field of surgery that was denied. She told me

>becuase it was an exclusion and not a medical necessity a Dr. would

>not be looking at it.

>

>I am sorry this is so long, I need help. I asked how can it become

>medially necessary if a Dr. never is part of the appeal. Did anybody

>win on appeal when their policy listed WLS as an exlcusion. I can't

>afford to self pay and even if we could, complications (if any) would

>be excluded. That is just a chance my family can't take.

>

>Also, when I mentioned they overturned for other with Healthsource,

>she became very annoyed and wanted to know how I found out

>confidential information. She wanted to know if Dr. R told me. I

>advised her we have a great support group and find out a lot about

>each other and I had some kind people share their sucess stories with

>me. Thanks for letting me vent. I had my hopes up that this would

>work, now they are dashed again. Rozycki, Denver, NC MGB

>hopeful since 2/19.

>

>

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