Guest guest Posted February 10, 2004 Report Share Posted February 10, 2004 Hi all, Just a quick note to let you know I just heard from my insurance company and I have won my appeal. They said they will try to have a check cut on Friday for me......OOOOO,,,,can you hear me screaming all the way from Idaho.... Thank you God and Dr. H for the many blessings that have come my way. Kim Whitney Dr. H 10-20-03 273-228 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 11, 2004 Report Share Posted February 11, 2004 What insurance company do you have? What did you include in your appeal? Thanks for your help. sueoyler@... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 11, 2004 Report Share Posted February 11, 2004 Hi Pam, My 3 pre-op denials were based on the original summary plan which stated they did not cover in-patient hospital confidments for WLS. My appeal to them stated that I was an Out Patient and therefore this should be covered under the plan..as well as the surgeon fee and anest. fee...since they did not state that those items were not covered, just the in patient stay, ie:; room and board from the hospital. They told me after 3 pre-op denials that I had exhausted my pre-op appeals and that if I wanted surgery I would need to pay for it myself and persue the post-op appeal process...so I did...Here is the great thing...from my last denial in August to my surgery in October...they revised the summary plan in September to cover WLS...so I just needed to meet their BMI criterial and whamo refund...But, had they not revised the summary plan I still would have won because their policy did not state clearly they didn't cover Out Patient procedures...ambigious wording and per my attorney it would not hold up in court...also, I copied the State attorney generals office and the State insurance comissioners office and my HR officer since we are a self funded plan and went to war...I really went after them with every argument I could find...I mean really I had nothing to lose....:0)...just weight..... I used my own appeal letter as I felt it necessary to address each and every statement about WLS in my summary plan, this way they know I read it and would debate it till the cows came home. It's fortunate that I also do this for a living , I work for a hospital and help people persue non-payment from their insurance companies....Kinda like been there done that. Good Luck to all of you Kim Whitney Dr. H 10-20-03 273-227.5... >>> " pam_holder2003 " <pam_holder@...> 02/11/04 12:20PM >>> Right on Kim! That's great news! Why did they deny you? Did you use my appeal letter? Thanks, Pam Holder > Hi all, > Just a quick note to let you know I just heard from my insurance > company and I have won my appeal. They said they will try to have a > check cut on Friday for me......OOOOO,,,,can you hear me screaming > all the way from Idaho.... > > Thank you God and Dr. H for the many blessings that have come my way. > > Kim Whitney > Dr. H 10-20-03 > 273-228 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 11, 2004 Report Share Posted February 11, 2004 Congratulations. I always LOVE to hear when insurance companies finally " GET IT " ...Congratulations for hanging in there and winning the fight! WON MY APPEAL Hi all, Just a quick note to let you know I just heard from my insurance company and I have won my appeal. They said they will try to have a check cut on Friday for me......OOOOO,,,,can you hear me screaming all the way from Idaho.... Thank you God and Dr. H for the many blessings that have come my way. Kim Whitney Dr. H 10-20-03 273-228 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 11, 2004 Report Share Posted February 11, 2004 Kim, what insurance company are you using?? Good for you!! 2-05-03 Joplin Drs. R & H 377/217 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 22, 2004 Report Share Posted February 22, 2004 Kim, I am appealing with BC/BS of California. I was wondering if you would share a copy of your appeal letter so that I can see what verbiage you used. I have also contacted an attorney and I am anxiously awaiting to see what they may be able to do to help me. e Jan 12 04 225/195 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 23, 2004 Report Share Posted February 23, 2004 e, I will share anything with you to help. Here is what happened. I was turned down 3 times pre-op..they told me I had exhausted all my pre-op appeals and if I wanted the surgery to have it and submit the bill after and we would go into the post-op appeal side. I did..and when I submitted my bill they asked for additional billing info. cpt codes etc..and approved it..this is because they had amended the policy to cover WLS 3 weeks prior to my surgery and I didn't even know it. You need to hook up with Pam Holder on this board. She is also being turned down for MGB as investigational procedure. She is writing one heck of an appeal letter and knows exactly how to address it... My suggestions to you, get a copy of your policy. Find out what mandates the MGB to be investigational in their minds and dispell each of those issues..get everything in writing from them... Good Luck Kim W >>> KDani1956@... 02/22/04 04:59PM >>> Kim, I am appealing with BC/BS of California. I was wondering if you would share a copy of your appeal letter so that I can see what verbiage you used. I have also contacted an attorney and I am anxiously awaiting to see what they may be able to do to help me. e Jan 12 04 225/195 Quote Link to comment Share on other sites More sharing options...
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