insurance denial question

Does anyone know if there is hope in appealing a denial with Humana choice care PPO if the exclusion wording is this: any treatment to reduce obesity including, but not limited to, surgical procedures. I am devestated over this because I called Humana twice before my consult and asked about exclusions and was told both times that it would be covered as long as it was medically necessary. Thanks for any help or advice. Pamela

Pamela, Maybe its the procedure that you were filed for. I talked to my insurance to check for rules and exceptions and I found out that laproscopic surgery is denied because the procedure code that the doctor files under comes up as an unidentified code. Maybe it's just the procedure that you are trying to get that is being denied. You can call your drs. office and get the codes then call your insurance and see which ones are approved. Deanna P.S. I have humana insurance also, but its tricare. I hope this helps.

there is a site called obesitylaw.com You may find some answers there. I would call Humana back and find out why it was denied. You may find out your Dr's coding, or whatever, was missing an element that is required or that the medically neccessary part was left out.