UHC insurance won't pay

Has anyone ever won on appeal to make insurance pay for costs of removal of lapband emergency surgery when they say  have a limit of $5000 for a lifetime?   My hospital bill alone was $23,000 and they have paid only about $3500. 

Need more info...

What insurance?
PPO, HMO...?
Self insured by company and they administer, or normal insurance?
Did they cover the original lap band surgery?
Was the lifetime cap on bariatric or any surgery?

You may need a lawyer to fight for you...because it's going to be a fight over interpretation of the contract itself. obesitylaw.com can help

Thanks for replying.  I am not that insurance literate, but I will try to answer to the best of my ability.

The name of this company is Health Plan of Nevada, they were recently acquired by UHC, so I don't know if that makes a difference.
It is an HMO.  I was a self pay for the original surgery, and my Dr is in CA, out of their network of course.
They paid part  to the Drs and part to the Hospital, but I feel that since it was done on an emergency basis, admitted through the ER, that it should be covered in that instance.
I believe the lifetime cap was on bariatric surgery.

I was just wondering if I had any chance since these HMO's pretty much write their own rules.
Is there any specific language I should state when / if I do my own appeal?

Thanks again for your help.

I still think this is going beyond self-help and needs a lawyer.

You are going to have to argue -

That even if they didn't pay for the original, that they should pay for the complications...

And that it doesn't fit into the lifetime bariatric surgery limitations...

On top of that, if you decide to get a revision/another WLS, you will have a fight there, too.

Thanks again, I think you are right.