Not sure where to turn...

Sara L.
on 12/6/06 2:40 am - Sheboygan, WI
My request for laproscopic RNY gastric bypass was denied on the belief that it isn't a covered benefit. This is rather silly, because there are at least three people that I know of who have had the surgery covered (same employer, same insurance plan, same medical diagnosis, same surgeon). The denial letter cited a "weight loss program" exclusion - surgery isn't a program, though! There is nothing specific about weight loss surgery. Anyways, I have written an appeal letter, and submitted it last week with copies of their own medical policies on the medical necessity of gastric bypass, as well as my own medical records, whi*****lude information on non-surgical weight loss attempts, psych eval, weight-related conditions, etc... - anything that proved medical necessity. How long do I have to wait to receive an answer? I know we always want answers to insurance questions yesterday, but my surgery was scheduled for December 19th, and I have to make arrangements for a sub (I'm a teacher). Does anyone have any suggestions? My insurer is Anthem Blue Cross/Blue Shield PPO and it is a self-funded plan through my school district. Thanks! Sara
(deactivated member)
on 12/6/06 10:59 am
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