Insurance appeal Update

I read over my benefit booklet and it states that all and any kind of weight loss surgery is not a covered benefit. My surgeons office submitted the paperwork for approval anyway because when I called my insurance company the rep stated that I could ask my surgeon to submit a medical necessity form if denied. So a week ago I received a call from surgical coordinator stating that my authorization was denied for wls. Of course I asked why and she preceded to tell me that she would rather me come into her office. So after work I dropped by the office to read over the denial letter/s. I was confused at what I was seeing. The first denial letter was because the insurance stated they needed more progress notes from the doctor and the office sent it over to the insurance company. A few days later the insurance company send a second denial letter  stating lack of medical necessity. Then a third and last letter stated denied because not a covered benefit. The process took an entire month with the back and forth. Why would they request all this additional info, if I did not have the covered benefit to begin with?.

Because the people working at these insurance offices are incentivized to deny you..for ANY reason.  I swear to god they make the reasons up as they go 

Everyone that requested information and sent letters was protecting their own job with the insurance company.  They are showing that they are necessary.  If surgery is not a covered benefit then they will not cover it no matter what the rep told you.

I read over my benefit booklet and it states that all and any kind of weight loss surgery is not a covered benefit. My surgeons office submitted the paperwork for approval anyway because when I called my insurance company the rep stated that I could ask my surgeon to submit a medical necessity form if denied. So a week ago I received a call from surgical coordinator stating that my authorization was denied for wls. Of course I asked why and she preceded to tell me that she would rather me come into her office. So after work I dropped by the office to read over the denial letter/s. I was confused at what I was seeing. The first denial letter was because the insurance stated they needed more progress notes from the doctor and the office sent it over to the insurance company. A few days later the insurance company send a second denial letter  stating lack of medical necessity. Then a third and last letter stated denied because not a covered benefit. The process took an entire month with the back and forth. Why would they request all this additional info, if I did not have the covered benefit to begin with?.

it being  a "not covered benefit" means your employer did not  buy the coverage for WLS for its employees,from the insurance company. 

About all you can do. Is change insurance,if possible or self pay.

Try calling your state insurance commissioner. Keep detailed notes file one level appeal after the other. You maybe want to call leagel aid they may only need a letter with a lawyers letterhead to get. It approved.     Good luck

If it is not a covered benefit, it's not a covered benefit. Sorry. All the rest is just bureaucratic foolishness.

You can buy really basic car insurance that covers the minimum legal requirement, but it won't cover collision damage. If you hit another car, they will pay for injuries, but they will never, ever pay to have your car repaired. Because you didn't buy that coverage.

Whoever bought your health insurance decided to save money by not purchasing weight loss surgery. And no matter what some idiot says, they won't pay for it.