Author Topic: plz look  (Read 5718 times)

Offline cnc990

  • Posting Member
  • *
  • Posts: 24
UPDATE:
2day i got the letter from the Gigna health care They gave me a long letter on why they dont want to cover me...this is what i got
Because:
The documentation sudmitted does not confirm that you have post pubertal onset gyn  That has persisted for one year;
The documentation does not confirm that you have grade two three or four
Gyn  as defined by the american society of plastic surgeons classification system'
it is not confirmed that your gyn is associated with persistent breast pain despide the use of analgesics

But they also say this later on in letter wich im having trouble understanding



The terms of the members benefit plan do not require advance approval for the requested service/procedure. We are providing this voluntary predertermination of coverage as a courtesy.This voluntary predetermination of coverage decision is not a treatment decision.a medical consulation or a claim denial.If the requested service/procedure is provided a claim may be submitted and we will make a coverage voluntary predetermination of coverage decision.If the claim is subsequently denied in whole or in part you will have the opportunity to appeal the decision at that time.Details on the appeal process will be provided in the claim determintion notice


SO ya i dont understand that relaly :(
plz tell me what u think

Offline milesed1

  • Silver Member
  • ***
  • Posts: 120
If those are all you need to fulfill to get it covered, you can probably take a little time, see a doc and report the required info to him, and send a copy of his note to them.

Offline cnc990

  • Posting Member
  • *
  • Posts: 24
well i just found out that my full time job does this program they do where they give me money cash like say i need 8 grand.Then is slowly comes out my pay check little by little each week..then i can clame it by the end of the year and get say 4 grand back in the bank..This sounds good.

Offline headheldhigh01

  • Senior Member
  • *****
  • Posts: 4079
  • destined to stand on a beach shirtless
not really that confusing. 

the first part is three reasons they think you would get denied coverage under their policy. 

the second part says three reasons is tough to go up against, you would have to show why these reasons aren't valid. 
* a man is more than a body will ever tell
* if it screws up your life the same, is there really any such thing as "mild" gyne?

Offline angel_allen

  • Silver Member
  • ***
  • Posts: 137
one out of ten- rubbish!

Offline headheldhigh01

  • Senior Member
  • *****
  • Posts: 4079
  • destined to stand on a beach shirtless
one out of ten- rubbish!
spoken by the fetishist who wants everyone to keep theirs because he thinks it's hot and he likes to drool over their pics  ::)  ::)  ::)

 

SMFPacks CMS 1.0.3 © 2024