Insurance Denial

[Guest guest]

Hi Pat.

I'm so sorry to hear that you have been denied by the insurance. By all

means keep fighting and get the appeal started.

Could the group please give Pat some pointers in this direction?? Someone

posted how to go about this few weeks ago.

When the going gets rough - the tough get tougher.

I feel that this journey is certainly not a walk in the park from the

get-go. From the time I made up my mind that this surgery

was definitely what I wanted it's not been easy. Many of my friends and

family were against it. I had to educate them and

I have done so. Most are on my side now as they know I mean business. And

for those who aren't - that's their problem.

Initially I had no Health insurance at all. Then I applied to two different

companies. BCBS/Fl. denied me coverage. Too fat and cholesterol and

triglyserides too high. Got the other companies approval only to find out

that one of their exclusions was any type of WSL. Then I called the

insurance commissioner;s office and some secretary gave me e the name of a

local underwriter here in town. After contacting him - he told me that

Aetna (U.S Health Care) had open enrollment/change of enrollment here in Fl.

during the month of

December. He sent me the application. From that application I found the

main number for Aetna and called and talked to a representative there. I

was told that my best bet was to apply for a PPO - POS (I understand that

means preferred provider

point of service ) if I wanted to have out of state out of network coverage.

So then I called the underwriter back and told him that I did not want the

HMO but the PPO- POS which will cover me in another state other than

Florida. He said ok but if so I had to be part of a group.

Fortunately, I have my own small business and was able to put one of my

youngest (Male) SLIM employees on with me.

As I posted earlier I send in that employees application with a check to

Aetna for $375.00 tomorrow. Previously I had sent in a copy of my business

license and a c copy of last year's 1040 with section C attached So the two

of us make a group- right.

So on goes the roller coaster ride.!! This MGB undertaking is certainly y

not for the faint of heart . Anyway this explains a bit of what I have

been experiencing so far along my j journey. I hope and pray to be able to

get this Aetna coverage in order

to move on. with my plans to " Dance "

I don't know if this helps at all Pat but just wanted to share this because

I'm really just turning towards the starting gate.

Don't give up - cry a few tears- I understand - try another tactic. Talk

to you soon.

Eileen (MGB Hopeful) Clearwater

P.S. Hope the insurance folks don't read these posts.----???