Insurance Gave Approval in Error now DENIED!

Has anyone had their insurance company make errors in telling your benefits and if so, did they go ahead and cover?  Did you have to appeal?

I originally called the member services number on the back of my insurance card and was told I have coverage for WLS.  The surgeon's office also verified coverage.  They were told I needed a psych eval, dietary consult and appt w/ the surgeon to submit to review for medical necessity.  After I did all that I was told WLS is an excluded benefit!?!?!?!?  I got an approval letter on Friday and a denial letter yesterday.  I am going to appeal, but my husband is in upper mgmt and he talked to the head HR and they did not believe it would be approved as he says the policy clearly says it is excluded. 

Just wondering if any of you have any experience with any similiar situations.  My insurance is through my husband's employeer and it is self funded with calls, claims, etc managed by BCBS Anthem.

Any advise is greatly appreciated!!!

So sorry you are going through this.  It truly is awful.  I just got approved after an inital denial.  A denial that came less than 24 hours before my scheduled surgery. However, my policy does cover bariatric surgery. 

Get an attorney.  Go on the internet and look up Obesity Law.  I looked into this during my appeal process.  Most said they can offer help for under $500.  At the very least they can tell you if you have a shot.

Is there any chance for you to change insurances - like maybe during an open period. 

Good Luck!!!

I am almost sure if they gave you a letter saying it was approved then they have to cover it. A lady at my surgeons office had the same thing happen to her, but since the insurance company put it in writing that it was covered they had to fight them well threaten to sue and they covered her surgery. I hope it all works out for you thou.