Denied my wls.....Need help on appealing

I was denied my wls 3 weeks b4 my surgery. I have already contacted my primary physician and my employer. The insurance I have now is Coventry and they won't pay a thing in this area. Prior to this past July, I had Amerihealth and it was approved then they changed to Coventry If my employer can't buy into the contract, do I need to take legal action w/ appeals? I have already been online looking up other healthcare places in DE. So far, BCBS approves the WLS but it's expensive to pay individually. HELP!!!!!!!!!!!!!!!!!

Lysa, so sorry to hear that. I wish I could help, but I did not have this problem. I will keep you in my prayers. Christie

Have you tried contacting Coventry to see why they are denying it? I had this same problem a couple of weeks ago with my insurance and when I called, I found out that there was not enough clinical information. I had to meet with a nutritionist and a pyschiatrist before they would review it again. I have already had the nutrition evaluation so I am just waiting on my psych evaluation now. I know it is frustrating...but I am sure that there is a light at the end of this tunnel. Robyn

Hi Lysa, So sorry to hear about your problem. I have no suggestions for you since I am just starting my journey. I have my first appointment on Nov. 4. Just wanted to let you know that I will pray for you and hope everything works out for you. Hang in there and please don't give up. Please let us know what happens.

Lysa, In the past Coventry has never covered WLS. If you can switch to another insurance company that does, do it asap. Others in the past have switched to a new company and had to start the process all over. Sorry. Or you will have to self-pay if Coventry is the only insurance offered. I have Aetna. You must be on a documented supervised weight loss program for minimum 6 mo. I think BC/BS also has this requirement. This has also held up folks in the past. Even then sometimes we are refused the 1st request and we have to appeal. Check out some of our profiles. It wasn't easy. But sooooooo worth all the effort. Good Luck. Elissa

I wish I could encourage you but Coventry does not cover WLS, and I am now finishing my 6 mos. supervised for my Blue Shield. Hope this works since I've been trying for almost 3 years. When your insurance has that "exclusionary clause", no appeal works because it isn't about you or your health but about your company's contract with the insurance company. BTW, I hope you don't have the same problem I had with CHRIAS, who scheduled me without knowing I would never be approved. Would have saved me a lot of heartache too. Carol