Exclusions/denials?

Hey everyone, just yesterday the insurance co. said my policy had an exclusion for ANYTHING obseity related and if I asked for precert they would deny it. I then asked if I could appeal, and they said you can't appeal UNTIL it has been denied (my first appt w/ surgeon is Thurs)- but to not waste my time because it would still be denied upon appeal. They said even if the Dr. said it was medically necessary. I have Anthem BCBS Blue Access PPO of KY? Has anyone had a policy exclusion, and how did they handle this situation? Did you go ahead, go to the dr. and let them file, get denied, then appeal? Does the appeal process work? Any and ALL comments no matter what would be appreciated Thanks in advance. I am devastated.

They told you not to waste your time?! How dare they! You have a right to file, then appeal as much as they allow. I'd go through all the hoops regardless what they say. It also may not hurt to check into obesitylaw.com and see what else you can do. Good luck! Stephanie

Hello Trisdee, Go to your surgeon, have him submit your preauthorzation. I have BCBS PPO of KY my open RNY was 12/10/03 and my husband was just notified last week that his wls was approved. He is scheduled for 4/21/04. Your surgeon will know the correct terminology to use for approvial. Also make sure that you have a letter from your PCP stating that the surgery is medically necessary, that you have had your psych consult, and nutritionist consult. If you are denied - Appeal!!!!! Good Luck Lyda Open Rny 12/10/03 298/228 (-70)

Hello Mine too was denied after a year later but there is things you can do... Like all the above and also you can look up these sites. I have a friend mailing me some pages from books about appeals. As soon as I get them I will scan them and send them to you.. Dont give up .. Fight fight fight that is what I am doing.... thanks

I forgot to post the link.. sorry http://doi.ppr.ky.gov/kentucky/Documents/Health/External_Appeals_revised_July_2002.pdf