Guest guest Posted December 28, 2002 Report Share Posted December 28, 2002 In a message dated 12/28/2002 7:17:52 PM Eastern Standard Time, hensleyct@... writes: > Ok some of you know that I have been in appeals with my insurance for > reconstruction surgery for several area's in my body. Well I wasn't > suppose > to find out until January 10th. Well after a very good day of shopping > with > my lovely husband, we returned home to find a letter from the insurance > company that once again DENIED me! Those DIRTY ROTTEN SON OF > (#*)&$*#())*(#*)(#@*)@&@)(*#*&*)(* @)&( @***$@(@((***&$#&@!($#(%&* > need i say more! ************************I know exactly how you feel. I'm going for the Level 2 appeal for my breast reduction. Same crap, they same no medical plan of treatment, blah, blah, blah. So, I made 3 appointments with 3 different orthopedic surgeons, hope to get similar letters from them saying that this girl NEEDS a breast reduction or you'll pay dearly! If they deny again, well, it's on to the Independent Review Board. I'm with you, I will fight to the finish! Good luck! in NJ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 28, 2002 Report Share Posted December 28, 2002 Ok some of you know that I have been in appeals with my insurance for reconstruction surgery for several area's in my body. Well I wasn't suppose to find out until January 10th. Well after a very good day of shopping with my lovely husband, we returned home to find a letter from the insurance company that once again DENIED me! Those DIRTY ROTTEN SON OF (#*)&$*#())*(#*)(#@*)@&@)(*#*&*)(* @)&( @***$@(@((***&$#&@!($#(%&* need i say more! Well needless to say they have just begun to know who Theresa Hensley is cause I AM NOT BACKING DOWN! **Letter states: The denial is upheld. The medical information & letter that were re-submitted w/the denial request do not determine whether more weight loss is expected. Further, there is no documentation that medical treatment has been tried (which is a bunch of bull). The denied procedures are consider cosmetic in nature and not a covered benefit as outlined in medical subscriber agreement.** I am still going in on January 13th for the Tummy Tuck and Ovary removal. Happy Holidays! Theresa *Nothing Tastes As Good As Thinness Feels* Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 28, 2002 Report Share Posted December 28, 2002 Whoa . . . read your policy, as most state that ANY medical treatment that hasn't been pre approved will be paid at 50% of benefits, IF it is determined that it was medically necessary. You need to slow down and prove your case before you proceed. First, they want to be sure you are done losing weight and then they want to be sure that your medical conditions will not improve if you are still losing . . . For you to get this much information from them is a blessing as they are giving you the weapons to fight their denial. Prove your weight is stable and that your medical necessity is on-going . . . and they may approve. Have surgery without their approval and you may be SOL . . . patience pays. I was denied for abdomnioplasty at 18 months post op and approved at 3 years+ post op . . . ) Vicki > Ok some of you know that I have been in appeals with my insurance for > reconstruction surgery for several area's in my body. Well I wasn't suppose > to find out until January 10th. Well after a very good day of shopping with > my lovely husband, we returned home to find a letter from the insurance > company that once again DENIED me! Those DIRTY ROTTEN SON OF > (#*)&$*#())*(#*)(#@*)@&@)(*#*&*)(* @)&( @***$@(@((***&$#&@!($# (%&* > need i say more! > > Well needless to say they have just begun to know who Theresa Hensley is > cause I AM NOT BACKING DOWN! > > **Letter states: The denial is upheld. The medical information & letter that > were re-submitted w/the denial request do not determine whether more weight > loss is expected. Further, there is no documentation that medical treatment > has been tried (which is a bunch of bull). The denied procedures are > consider cosmetic in nature and not a covered benefit as outlined in medical > subscriber agreement.** > > I am still going in on January 13th for the Tummy Tuck and Ovary removal. > > Happy Holidays! > > > Theresa > > *Nothing Tastes As Good As Thinness Feels* > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 28, 2002 Report Share Posted December 28, 2002 They HAVE approved the Tummy Tuck its a couple of other area's that do get infections and can cause a lot of problems down the road if not fixed. But I do agree with you they have given me some useful information that in the long run will better my case and hurt their denials. Thanks Vicki! Happy Holidays! Theresa *Nothing Tastes As Good As Thinness Feels* -- Re: BAD NEWS Whoa . . . read your policy, as most state that ANY medical treatment that hasn't been pre approved will be paid at 50% of benefits, IF it is determined that it was medically necessary. You need to slow down and prove your case before you proceed. First, they want to be sure you are done losing weight and then they want to be sure that your medical conditions will not improve if you are still losing . . . For you to get this much information from them is a blessing as they are giving you the weapons to fight their denial. Prove your weight is stable and that your medical necessity is on-going . . . and they may approve. Have surgery without their approval and you may be SOL . . . patience pays. I was denied for abdomnioplasty at 18 months post op and approved at 3 years+ post op . . . ) Vicki > Ok some of you know that I have been in appeals with my insurance for > reconstruction surgery for several area's in my body. Well I wasn't suppose > to find out until January 10th. Well after a very good day of shopping with > my lovely husband, we returned home to find a letter from the insurance > company that once again DENIED me! Those DIRTY ROTTEN SON OF > (#*)&$*#())*(#*)(#@*)@&@)(*#*&*)(* @)&( @***$@(@((***&$#&@!($# (%&* > need i say more! > > Well needless to say they have just begun to know who Theresa Hensley is > cause I AM NOT BACKING DOWN! > > **Letter states: The denial is upheld. The medical information & letter that > were re-submitted w/the denial request do not determine whether more weight > loss is expected. Further, there is no documentation that medical treatment > has been tried (which is a bunch of bull). The denied procedures are > consider cosmetic in nature and not a covered benefit as outlined in medical > subscriber agreement.** > > I am still going in on January 13th for the Tummy Tuck and Ovary removal. > > Happy Holidays! > > > Theresa > > *Nothing Tastes As Good As Thinness Feels* > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 29, 2002 Report Share Posted December 29, 2002 Hang in there girl! And I think they think that oh they will give up no problem. But I don't think they understand the servairty of why we need this done. I don't care if I look like Janet , Pam or heck I don't even care if I look like Twiggy. What matters its the health that matters and yes fitting into the clothing like is important to protry a professional appears. So Either approve me OR meet the maker cause this girl will die trying. Happy Holidays! Theresa *Nothing Tastes As Good As Thinness Feels* -- Re: BAD NEWS ************************I know exactly how you feel. I'm going for the Level 2 appeal for my breast reduction. Same crap, they same no medical plan of treatment, blah, blah, blah. So, I made 3 appointments with 3 different orthopedic surgeons, hope to get similar letters from them saying that this girl NEEDS a breast reduction or you'll pay dearly! If they deny again, well, it's on to the Independent Review Board. I'm with you, I will fight to the finish! Good luck! in NJ Quote Link to comment Share on other sites More sharing options...
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