Got primary insurance rejection today!

December 31, 2004

Yea! I know. Sounds weird, eh? But my primary insurance through

my employer will not cover WLS. It is a listed exclusion. They

will be adding it to the policy later this year but not until July

1. Appealing won't work. Our company is self-insured and approving

surgery based on an appeal means that the company does not get

catastrophic insurance on the person for the procedure. In other

words, if something goes wrong...the company is liable for all the

hospital/doctor costs and that could amount to tons with serious

complications. Whereas now, if someone goes for an approved

surgery... the company is insured over a certain figure for

catastrophic care.

Anyway, now that I'm rejected by my primary insurance and it appears

that my secondary insurance is finally getting established - that

we'll have the doctor send the papers to the secondary with the

rejection from the primary. I just mailed the check to the

insurance company to cover me from 11/22 (date of marriage) to

today. And we mailed the first quarter fees for 2005 to them last

week. Long story....as in the insurance company saying " our

software cannot figure out how to prorate the fees " . Duh. What

morons. So, this all should be fun!

I do know that PHCS (secondary) requires alot of that dreaded diet

history. I'm praying that what I wrote up...a four page history of

my dieting life plus some computer printouts I have of dieting in

2003 (I did lose weight just didn't keep it of) with a week by week

weight for 10 months of the year will suffice. Keep positive

thoughts please!

Kathy

December 31, 2004

> After all, they covered Rich right?

Well...it's the same company that he gets insurance from (AFTRA -

American Federation TV and Radio Artists) but the administration was

Beech Street when he filed for approval. Once he was approved,

AFTRA switched from Beech Street to PHCS. PHCS paid for what Beech

Street had preapproved. Got that? LOL.

Recommended Posts