Exclusion on Insuance

[rjdow 0]

I am trying to get our insurance to cover my surgery however it is an exclusion on our policy. I am trying to appeal it and was wondering if anybody had any advice. I have wrote one appeal letter and got a NO but I am not willing to give up that easy!!! Someone said something about writing a letter to the company that my husband works for since we are self insured instead of going through the insuarance underwriters does anybody have any advice???

I take any help that I can get on this!!!!!

[piercedqt78 658]

I was denied 3 times, don't give up. I contacted my husbands employer and they made the insurance company pay for it. We have the option of 2 insurance companies and one covers it and the other (ours) did not. I fought it and now they have to cover it for the people that work for my husbands union. I am happy to say that becuase of my fighting others will be able to be covered. Don't give up, fight until there are no appeals left and then ask for an outside appeal, I know it is hard to wait but my $22,000 surgery was covered 100%. Sometimes waiting is the only way~Mandy

[txbldhnds 0]

I was in a similar situation, but was not able to get them to pay. I understand that there are attorneys that will fight it for you. When I was doing resource for my appeals, I came across some websites, but did not save the info. Sorry!

I was able to self-pay through a series of events both unhappy & happy.

One lady I know who had several co-morbidities was able to get her insurance company who had exclusions to pay by having her lawyer write the insurance company saying that if she died from one of the stated co-morbidities, her family would sue the insurance company. This was while the procedure was still in clinical trials. She was successful, both in getting her insurance company to pay and in losing her weight and keeping it off. She looks and feels great!

Good luck!

Colleen

[rjdow 0]

Ok so if you don't mind me asking what union is your husband in. My husband is in the awppw. The other insurance that is offered I believe pays for it. The only concern that I have is that they are self insured.... However, on my next appeal letter I am going to send a copy of it to his employer and not just the insurance company to see if that helps any. I won't give up until I win the war!!!! In the meantime I am trying to save as much money as I can so I can pay for it myself as I am very impatient and want to start my journey as soon as possible. I am very impatient but I am not a quitter!!! If any one has any good ideas I am all ears!!

Robin

[piercedqt78 658]

My husband is in the UTU (united Transportation Union) He works for the rail road. Since they are under a collective bargaining agreement they cannot exclude a proceedure on one insurance and cover it on the other. It may not be the company excluding it but the insurance, and your husbands company/union may not be aware of the exclusion. That was the case with me. When I called the union it was as simple as them confirming that United Health Care would pay for it, that is our other option, and then they called highmark BCBS and made them pay for it. The UTU is also self insured, and now highmark BCBS must pay for the band for UTU employees and their families if they qualify. I feel like I not only helped myself but also others on this journey. It was a bit difficult since I am the first to be covered by them, and they have not made the decision to cover adjustments yet, but I will fight for that too ~Mandy