Well, it's been officially over 6 months since my first appeal being denied which means,supposedly (according to my job's insurance contact), I can re-sumbit my full/complete packet for surgery once more. This time they will submit as a whole new request. We have gathered additonal and new documents so if i dont get it passed this time, i'm out of luck for surgery (selfpay is not an option for me).

Through countless appeals (another long winded story in itself) and my insurance not giving accurate information, this process has been excessively long/draining/frustrating.

I still have a complaint filed with the state's (pa) insurance commissioner. Whether it helps my case or not someone needs to know that insurance companies cant/shouldnt treat their paying memebers this way. We should be given any and all info and informed properly of procedures and information if/ when we ask for it!! Plus, maybe it will help someone else who may be going through the same thing...although who knows!! Has anyone had any experience with filing a formal complaint? Did it help you in your case?

Any who, i'm hoping this will be it and i'll have an answer by the end of july. The "approved" answer. Im staying as positive as i can.

As always, good luck to all!!

Sharon..... i hope everything works out this time....

Or you can quit your job, be a lazy ass, drain on the economy and get medicare and medicaid and let the gov. pay for it.... like some.

Wishing you luck- not fun right to have something that can help change you life for the better

Thanks guys...i hope so too christina!! My husband now just shakes his head anytime i mention the latest news/ progress. I pretty much keep it to myself nowadays. Lol

you know my email... if you want to chat go to Chat....and we can talk

SharronK---This wouldn't be BCBS of PA is it? Just wondering. This sounds very similar to what my girlfriend is going through. No one can figure out what else they want. The surgeons office said they (insurance comp) won't reveal what the problem is. And when they ask, they are sent the same copy and paste handbook requirements...but both the surgeon, the nutirtionist and and the GP doctor say they have done everything they are requiring.

If this is the same company, I'm going to tell her to file a complaint too. This is crazy!! It just seems like they have to tell you what they want!!

Good luck.

I have highmark bcbs which is located out of pittsburgh...not sure if thats the same but DEFINITELY sounds familar. She should fule a complaint!

I am not sure who it was on this forum but there is a firm of legal people that specifically deal with appeals against health insurance denials .. someone on this forum reported using them at some time, i am sure if u google it u may be able to find them, it sounds like u could do with some professional help with your appeal .. good luck !

Yes, i know of it. Not really looking to spend the money. Thanks though!