Question:
Yesterday I was notified that my case was before the review bd. Today I was denied!
Yesterday I was told that my case was before the insurance company's medical review board and that I woyuld hear in 1-2 weeks. Then, today, I received in the mail a letter of denial! Gee, they sure worked fast! Does that sound crazy to anyone else or is it just me? What should I do now? I'll appeal, of course. Thanks for your advice. bmi 41.7 arthritis, depression, sleep problems -- but denial letter said I have "nothing life-threatening." — [Deactivated Member] (posted on June 24, 1999)
June 24, 1999
Who's your insurance carrier? My my co. just approved with a BMI of 41.3.
That's life threatening enough! What about shortness of breath, back pain,
effect on work, etc... Maybe you could go back and have your Dr. write a
more convincing letter. Any family histories of heart or lung problems?
GOOD LUCK AND DON'T GIVE UP!
— Fran W.
June 24, 1999
You mention sleep problems. Have you been tested for sleep
apnea. That is a life threatening problem but it has to
be diagnosed first.
— dboat
June 24, 1999
No, and The post office doesn't work that fast either. If you got the
letter of denial the day after the phone call advising you're being
reviewed by the board ... that doesn't happen unless they've first denied a
claim and then they take it to the board in somewhat of an appeal process
to make an exception to the denial. I would call and confirm that ... but
I was in insurance for 13 years. I believe you'll find that is the case.
Good Luck!
— Sherrie G.
June 24, 1999
Ann, They would have had to mail it before your phone call. My guess is,
that it was denied automatically and then as a matter of practice it gets
directed to the review board for further consideration. Call them again
and ask what the story is. Do not lose heart, this is worth the fight.
Many, Many times as a matter of procedure these surgeries are denied the
first time. Good luck!
Mary Anne
— Mary Anne M.
June 28, 1999
YOUR INSURANCE COMPANY SOUNDS LIKE MINE WAS. IF YOU SUFFER FROM SLEEP APNEA
AT YOUR BMI I WOULD THINK THAT WOULD BE LIFE THREATENING ENOUGH. HAVE YOU
HAD A SLEEP STUDY DONE?
MAYBE THAT WOULD PROVE YOUR CONDITION WARRANTS THE SURGERY.
GOOD LUCK, AL
— AL M.
Click Here to Return