DENIED

I knew it was going to happen but when i heard her say that i was denied i started to cry. i finally found a job with a boss that is great. he told me to get insurance, any insurance that would cover the procedure. well, here in florida all insurance companies are now writing "obesity surgery" in their exclusions. i dont know what to do next. i was hopeing to have the surgery before the end of the year. i am a bookkeeper and i cannot take the time off of work for the surgery between the months of january and april. now that i have been denied i have to wait till atleast may to have the surgery (that's if i am approved) the woman from the insurance company said that i could appeal it and it would definately be a battle. she is sending me the appeal info via fedex so i will get it by monday. but there is no way that i can have the surgery in time for tax season. does anyone have any suggestions on how i can appeal this and what my first steps should be to getting approved? please help

Robin, I don't know anything about appeals, so I can't give you any advice there. I do know that in Florida you can take your paperwork from your denial to Vocational Rehabailitation and if you qualify medically, they will cover the surgery. Please don't give up! I'm so sorry about your denial. Hugs, Erika L

Hey, I am so sorry that you were denied. I have worked in the insurance field since 1992. I can tell you that it is not necessarily the insurance companies who write the exclusion. It is usually the employer. The insurance company will cover what ever the employer wants to be covered. Of course taking the cost into consideration there are a lot of employers who will write an exclusion for weight loss surgery.. It is the employer who tells the insurance company what they want covered, how much they want the copays to be etc.. Please don't get discouraged, you definitely need to appeal. I have UHC Choice Plus PPO and I was just approved on 11/23/04, my friend also has the same insurance exactly, works for a different company that placed an exclusion in their policy with the insurance company and she was denied. Just keep your head up and keep trying. Shannon

My prays are for you! Do not give up! Prays are going up for you.

Hi Robin, All told, I was denied five times (two different docs). My first appeal was a self-appeal, which I am happy to share with you (even though it too was denied). I ended up securing an obesity law attorney, which did the trick. What insurance company are you with? Kristen

i have humana. hopefully i wont have to get an atty to do this. i figure what i will do is go see every specialist i can and have them document everything that is wrong with me that could be obesity related. so far the only thing i have been officially diagnosed with is a fatty liver. it's obvious that i'm obese, lol. ive been told by my ex that i do have sleep apnea but ive never seen a doctor about it. i know i have problems with arthritis in my knees. but other than that i'm the ideal bill of health. perfect blood pressure, cholesterol and blood sugar was low last time i had it tested. but this time i will eat a pound of sugar b4 my blood work if i have to, lol. i'm 29 and weigh over 400 lbs, i'm at the highest weight ever and diets DONT work. i just dont understand why ins companies wont pay for the surgery. it would be cheaper for them in the long run if they did. i mean, by the time they pay for specialists, medications, hospilizations. greedy *******s, lol

Most companies will pay for the WLS if you have Sleep apnea. You needed to have you I's dotte4d and your t's crossed before you submitted the request. Go get a sleep study done. Then appeal.....Even though it maybe excluded they may cover it based upon necessity.