how do I fight the insurance company?????

I am wanting to get bypass surgery.  But my insurance company "does not provide any weight loss surgeries even if deemed a medical necessity."  So how do fight them?  I am told I can do it.  But know one tells me how to do.  Can I get some advice Please? Thank you Andrew

Sadly, if there is an exclusion like that there isnt much u can do unless u can and wanna self pay.  Policies change sometimes though and I will pray that your does. Goodluck

I'm not familar on how to fight your employer when comes to exclusions. I'm sorry for the trouble you're going through to get a surgery, that for many of us, is so very necessary. The only thing I could encourage you to do, because my Dh and I had to do it, is to change insurance policies.  We had the hospital's insurance and this particular insurance didn't cover any type of WLS. In order for us to proceed, we had to change policies that didn't have any exclusions. If where you work offers an open enrollment, I would encourage to find out what different insurances they offer and which one covers the surgery.  Good luck to you-- Dee  

Hi Andrew,

It sounds like you have already done this, but if you haven't, get the insurance co's written policy, if there is an exclusion for WLS then I would go to your Humand Resources Dept. and ask them if they would think about changing their policy. I didn't realize at  first that employers can choose what they want the Ins. Co's to cover for them, by doing so it affects the rate they pay for coverage. If you do go to your HR dept I would go with facts in hand about how it might cost them on the front end but on the whole it would save them money in the long run. If that doesn't work self pay may be an option. Before  having surgery I would have never thought about self pay. But after getting my life back so to speak, if that is what I had to do I would look into that option. I am not sure how much it would be, but if it ran 25,000, that is about the cost of a new car. Your life and health are worth more than a car.  pan head

One thing that may bright'n your day that I was not told, until I just thought there was not any hope. A freind of mind told me that she was having WLS. I told her that wasn't even a possiblity due to the exclusion in my ins. policies. She asked if I had checked the insurance recently? Of course it had been a yr. My reply No.She then went on to tell me that ins. policies change every 3 mos.  Contact your HR or Ins. provider and find out when was the last time the policy had been changed.  Then mark you calendar.  Every 3 mos. make your phone call to your ins. company to find out if the exclusion has been lifted.  G

If the exclusion is at the request of the employer, you will have to get them involved, just like the other poster said. 

When you contact them, try to bypass any middle managers and go straight to the head of HR with a well written letter, explaining your comorbidities, your dedicatoin and commitment to the company and your desire to get the medical treatment needed. If possible, include pictures of yourself before the weight gain and yourself currently.  Include a section about how you could be a better employee if you were healthier (more stamina, more energetic, etc.)  And finally, if you have a letter of medical necessity from your PCP recommending the surgery, include a copy of that.  At the end of the letter, request a meeting to discuss how you can get a third party medical review of your case to make a recommendation to the compay.  The third party not being the insurance company or your employer. 

Good luck and God bless.