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2nd regection of Liver Transplant in Heb B & HIV+
May 2, 2004

I had my prevaluation(which Capital Blue Cross of PA approved!) at Starzl Transplant Center in Pittsburg. Dr. Fung( who will do transplant) & Dr. Rani (HIV expert for transplant) have done a paper. Dr. Fung sent this to Insurance company. It didn't even take them a week to reject my case. Any suggestions other than taking to court? What about filling an appeal with my state's Insurance Commision?

Response from Ms. Franzoi

There is an appeal process under health plan. When your insurance company denied your claim, they had to give you the reasons for the denial and reference the reasons back to plan provisions. You should reveiw the denial carefully and then file a formal appeal pursuant to the appeals provisions in your health plan. If you are covered under a group health plan, you might consider seeking the assistance of the Benefits Department to assist you with your appeal. Of course, you can always contact the state insurance commisioner in your state for assistance.



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