Insurance company denial

I have Carefirst BlueCross BlueShield, small group and have been denied coverage for lap-band procedure, due to it being a non covered benefit. Has anyone been in my situatution and succeeded in getting the insurance company to reverse their deceision? I am now going to Maryland Insurance Administration. Any other suggestions? Thanks, Sally

That small group exclusion is so frustrating Sally. I didn't have to deal with that myself. Good luck in your fight. -Daniel

My DH seems to be having the same issue with a small employee group exclusion under BCBS....I am not sure if its worth his time to appeal or go another direction to get coverage. I would be interested to know what you find out. KIT Thanks Karen

Sally, I wish I had an answer for you. Unfortunately small businesses tend to exclude things that larger corporations usually include in their policies. Don't give up in your fight to get the surgery. Take Care, Terry

I had the same problem. Have decided to work on going the route of self pay. I am going instert a reply here that i received - i posted the same question back in July. I hope it helps. You will have to keep me posted. RE: Insurance issues are in my way! Response from Michelle Engelmann at 2:41 PM PST on 07/28/2006 North Bethesda, MD - DS (07/20/2000) Kelli- I'm sorry to say there is no mandate that forces insurance companies in the state of Maryland to pay for WLS even if there is a medical necessity for those in a small group policy, which you fall under as self-employed. There isn't a loophole hole right now in the MD law unless there is something in your policy itself that says it will cover for medical neccesity. Michelle Engelmann Vice Chair Maryland State Task Force to Study Utilization Review of the Surgical Treatment of Morbid Obesity