Needing some guidance

Humana PPO denied my DS approval because they have an exclusion for "no treatment or surgery for obesity"  I appealed to Humana, that I am Morbid Obese, but they still denied me.  I then sent a complaint to IL Insurance Commission - because they do cover Severly Obese, (same thing as Morbid Obese, in my eyes).  My question is when I called to check on my complaint - I asked if the result comes back not in my favor, is this my last option?  They said no, you just filed a complaint against Humana. Ok, where do I go from here - should the complaint not be in my favor?? I greatly appreciate any guidance I can get.    Debbie

Dai, you will need to find out what exactly is their definition of Severely Obese.  If you fall in that range or if the plan document is poorly written and doesn't include a definition than you might have a chance.   Unfortunately, many plans specifically exclude surgery for obesity regardless of whether it is medically necessary.  If you are covered through an employer that has a self insured health plan, then your employer controls the benefits and the insurance company is paid to administer the plan.  If this is the case you may have some options through your HR department.  Ihope this helps