Question:
Trying to obtain 200 stories from people who have had surgery for my ins appeal.
THIS IS TOTALLY LEGITIMATE. I HAVE BEEN DENIED TWICE BY MY INS. CO. (COMPANION HEALTHCARE). I'M GOING BEFORE THE REVIEW BOARD TO STATE MY CASE. SOMEONE ELSE GAVE ME THIS IDEA AND I THOUGHT IT SOUNDED GOOD. I'M ASKING 7 QUESTIONS AND IF YOU EMAIL BACK THOSE ANSWERS IF YOU'RE INTERESTED IN HELPING ME. [email protected] - MY NAME IS DEBBI KIGHT AND MY PROFILE IS IN SC. HERE ARE THE QUESTIONS: 1. DATE OF SURGERY: 2. WEIGHT AT SURGERY/AGE AND HEIGHT OR BMI (OR LEAVE BLANK) BUT I DO NEED WEIGHT AT LEAST. 3. YOUR HEALTH AND MEDICAL CONDITIONS BEFORE SURGERY. 4. HOW MUCH YOU'VE LOST TO DATE. 5. HOW YOUR CONDITIONS,ETC. HAVE IMPROVED SINCE SURGERY (MAINLY MEDICAL BUT EVERYTHING WOULD BE INCLUDED.) 6. ANY INFO YOU MIGHT WANT TO SHARE ABOUT THIS SURGERY OR ITS EFFECT ON YOUR LIFE. 7. NAME AND EMAIL ADDRESS (I ONLY ASK FOR THIS IN CASE THE INS. CO. WANTS TO VERIFY MY INFORMATION) WHAT THIS IS FOR IS TO SHOW THE INS. CO. THE MEDICAL CONDITIONS THAT OBESE AND MORBIDLY OBESE PEOPLE COMMONLY HAVE AND WHAT A MAJOR DIFFERENCE THIS SURGERY HAS ON YOUR HEALTH, OUTLOOK, LIFE IN GENERAL. IT WILL BE COMPILED AND A COPY GIVEN TO THE INS. CO. TO SHOW THAT I'VE RESEARCHED THIS SURGERY (I HAVE ARTICLES TOO) AND KNOW WHAT I'M GETTING INTO AND THAT I DESERVE TO LIVE AND RIGHT NOW WITH ALL MY HEALTH PROBLEMS I FEEL LIKE THEY ARE JUST TELLING ME I'M NOT WORTHWHILE AND THEREFORE NOT WORTH LIVING. IF ANYONE HAS ANY QUESTIONS - I'LL BE HAPPY TO ANSWER THEM. THANKS, DEBBI (I DON'T KNOW IF I CAN EVEN POST SOMETHING LIKE THIS HERE BUT IT'S WORTH A SHOT ANYWAY.) — [Anonymous] (posted on July 18, 2001)
July 18, 2001
I don't know about any of the other 25 people that you sent this same email
to yesterday feel, but I certainly would appreciate being able to read your
profile here on AMOS before I send out this kind of information. Why did
you post this question anonymously? I don't mean to be mean, but this is a
lot of personal information you're asking for without even sharing YOUR
name.
— [Anonymous]
July 18, 2001
I have no problem helping out in any way I can. I sent my information and
if this site is not for supporting each other than what good is it. To the
previous anonymous poster, you shouldn't be so hard on Debbi she is only
asking for help for anyone who would like to support her, she is not
forcing you to support her or asking for your negative comments about her.
Debbi- I wish you the best and my prayers are with you.
— Sherri M.
July 18, 2001
I can certainly understand how frustrated and disappointed you
are; but, your plan to "appeal" your denial with a bunch of
undocumented case histories won't help at all. I've worked for
insurance insurance companies and in the finance departments of
hospitals for over twenty years...currently part of my job involves
appeal medical necessity denials...so I have some experiences in these
matters. You could submit 10,000 stories and/or case histories and
it wouldn't sway your insurer. The denial was based on their medical
guidelines or on contratual exclusions. If you are going to win an
appeal you have to refute the reasons for the denial. You didn't say why
they denied your surgery; so, it's impossible to offer any real
suggestions/
guidance.
— [Anonymous]
July 19, 2001
Debbi, Fist, I want to wish you luck in your appeal. My initial reaction
was to send you my information, but the more I thought about it, I think I
agree with the previous poster who suggested addressing the issues in the
denial letter. Your legal basis for appeal will be to prove that the
criteria the insurance company used to exclude you DOES NOT APPLY to your
particular situation. You need to look thouroughly through your policy and
specifically at what it DOES cover. Then, you need to show how this surgery
DOES fit the criteria of what IS covered. Good luck.
— Maria H.
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