2nd Denial from Highmark

Well, I have been denied a 2nd time by Highmark. I submitted over 40 pages of medical information and citations and they said they still won't cover it based on their stance of "investigation/experimental".

They said they have only covered one other company and that's the Railroad workers. I have no clue what they did but I need to find out. I but they bought a rider for their policy and now it's covered.

Now I appeal to my company. We'll see how it goes. I am absolutely not giving up and I'm NOT getting bypass no matter how much these insurance people push me towards it.

God, I am just so sick of this never ending battle!!!! It almost feels hopeless but I just have to stick with it. I see folks on here that battle for 1 year or more and finally get what they deserve.

I wish you all better luck then I've had!!

Gina B.

GinaB it sounds like you need the services of an attorney. Even medicare no longer deems Lap Band experimental. Sounds like the old run around. Get some legal help.

Is the experimental/investigational label the only reason for denial? Sometimes they through so much other *criteria* in the mix that it makes it almost impossible for approval.

M

I am the reason that they cover the railroad workers. You have to appeal appeal appeal. Take it to an outside review board. You have to be denied 3 times and then they will go to an outside review. I was told that it is almost always covered when it goes to an outside review. The outside review looks at the medical reasons, not the compaines policy. If you have any questions PM me, I will help if I can. ~Mandy