%^%$$#@ Insurance Companies!

After spending 6 months researching every aspect of gastric bypass surgery, I was told today by my insurance carrier, "surgical and non-surgical treatment of obesity, including morbid obesity" is not covered. Anyone out there in cyberland have any suggestions? Im wondering if that statement of denial means absolutely NOT, forget it and move on!!!!.... or... has anyone been successful in fighting it... with a documented medical history negating the neccesity of the procedure? My background in the medical field tells me to move on and that this is a lost cause, but I thought I would throw the question out there and see if anyone has found themselves in the same boat and may have a tip or two. All comments pro or con would be appreciated. Thanks for your time.

Who is your insurer? I was told the same thing but was later approved. I think there may be a law in Georgia that states you must have it if medically necessary. You need to complain to the State of Georgia Insurance Commissioner. They have a website. Do not give up just yet. That is what the insurance companies want you to do.

Lori, hello! I agree with Lisa! Our ins comp tried to keep me from having it and I did get in touch with the ins commissioner and with their help and my determination I got it done! DONT GIVE UP! Make them give you a copy of the policy so you will know exactly what it states so you have something to fight with!! Thats when my ins comp messed up! I m a nurse and demanding the policy and it stated if it was Med Necc then I could get it! SO GOOD LUCK!!! Kerri

Thank you for your replies. I checked out the certificte of coverage, riders, amendments and notices manual today and saw the same disclaimer......my question is, is that the same thing as the actual policy? Im always ready for a good fight, but if United Healthcare does not cover anything related to obesity, whats the point? You both have been great.....Im open to any suggestions at this point....keep them coming!

Lori, hey! Sounds like that maybe a type of policy but couldnt be for sure without seeing it. Call them and tell them you want an actual copy of the policy or ask them if that is what you have! I d still hit the ins commissioner and the atty that someone mentioned. Dont give up! IT s your life they are playing with! You know theres an old saying everything is meant to bend or get bent! You just have to find the right one to bend! Pardon me for doing so but I just done a quick run thru at the UHC website. They have a specific clause stating that if you are in a medical necessary condition then it has to be in the managed care area for prompt and cost effecient use! Hopes this helps! Heres what it has : Learn More About the United Health Foundation: Providing support and information to our communities for better health outcomes Specialized Care When a person is diagnosed with a serious illness, they rarely have the luxury of time to do all the research, interviewing and evaluation necessary to make informed, confident decisions about every aspect of their care. UnitedHealthcare has taken on this very important responsibility for our consumers, offering specialized network programs that seek them out and connect them with medical professionals and facilities renowned in their area of practice. Premier Medical Centers We choose our specialized medical center partners based on their program breadth and depth, patient and family-oriented programming and services, program volumes and clinical outcomes. We ensure a high level of care by considering the facility's: Clinical research Treatment planning and coordination Positive referrals from physicians Cancer Resource Services Even when a patient is diagnosed with an uncommon or highly specialized form of cancer, we have the resources to connect them with the premier cancer centers for their treatment. Nurse consultants work with individuals, their families and their physicians to make informed decisions about their cancer care providers. In addition, they coordinate and communicate with the specialized center about initial and/or local treatment efforts. Transplant Management Solutions As the use of transplants as a treatment option increases, it is absolutely crucial to have relationships that enable fast, seamless communication between care providers and transplant programs. Our Transplant Benefit Management Program offers just that and much more, guaranteeing clinical excellence. Related Information Specialized Networks: Enhancing Care for Patients with Serious Illness

I saw the other day on the national message board someone who advised he is an attorney and has offered his help to anyone that needs it regarding getting approved for WLS. I went back through the post for a few days ago and his name is Joe Bartlett, you can get him an email through his profile and he promised to answer any questions he could and to help any of us that needs it. Maybe this will help you, I'll be praying for you..Hugs, Theresa