Insurance coverage for WLS for 16 yo daughter?

Linda O.
on 10/21/07 11:07 pm - Silver Spring, MD

Having watched me go though my process, my daughter is interested in having RNY. Her primary care physician, along with my surgeon, are in support of and have recommended WLS for my daughter; however, our request has been denied by Kaiser because she is under 18. Her BMI is 51, she is pre-diabetic, has PCOS, and has high insulin levels. Does anyone know of someone under 18 who was able to obtain insurance coverage? We are in the process of gathering together information for an appeal and would greatly apreciate any suggestions on how we might make our case. Thanks! Linda

gary viscio
on 10/22/07 3:47 am - Oceanside, NY
RNY on 07/01/03 with
It's very hard, so you'll need to prepare. The surgeon really needs to make the case for medical necessity.  Then research cases under 18 in the US to try and get some statistics.  There really aren't many.  But, that doesn't mean you should give up or she doesn't deserve it.
Gary Viscio
www.ObesityLawyers.Com
RNY 7/1/03  -166lbs
Linda O.
on 10/25/07 11:40 pm - Silver Spring, MD
Thank you for your response Gary, I really appreciate it. I was also wondering if there were any possible legal ramifications I could mention in my appeal, such as the fact that she is high risk for diabetes, heart disease, etc. and that she is being denied an available and effective treatment just because she isn't 18.  Thank again, Linda
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