Employer Exclusion ... DENIED!

Hello ... I received the dreaded "DENIAL" letter today and am preparing to pursue the appeals process. The specific reason cited for denial of WLS was: "Under the _____ plan, benefits are not available for Health services & associated expenses for the surgical treatment and non-surgical, medical treatment of obesity (including morbit obesity) are excluded." Oddly enough, the district chose to see to it that TODAY I should receive the "policy guidelines" for the insurance policy that has been in effect since JANUARY 1 of this year! Last year's policy DID cover WLS ... the new policy does not! (((Of course I didn't have this information until AFTER I'd spent multiple hours upon hours pursuing this option and I remain CONVINCED that WLS IS my hope for a healthy, productive life. Has anyone had experience with specific exclusions in their policies? How about policy changes wherein the specifics are published AFTER the policy goes into effect? HELP???? (((& thanks!))) jeanne [email protected]

Jeannie I am in the exact same shape you are in sweetie...I feel completely and totally hopeless at this point. Mine is also an "exclusion" under my plan and I went so far as to file a grievance with my insurance...had family, friends. my PCP...cut out various articles regarding both the benefits of this surgery and the devastating effect that morbid obesity has on then health of individuals, letters form my 2 uncles who have had the surgery and lost a combined weight of over 450lbs and are off all their previous medication and STILL it was denied and the ONLY explanation given was it was an EXCLUSION in my plan!! BAH!!! My BMI is 66.4 heart disease, diabetes, stroke and asthma all run rampant in my family along with obesity and like you THIS is realistically that LAST option I have to get my wight and co-morbidities under control but obviously my employer does not care enough to try and at least pay a portion of this. I am loking for suggestions and help as well, I am at my wits end about this. I have researched this surgery for 4 years and in that time ben on every weight loss program known to man before finally taking the plunge and deciding to have it done, I never in a million years dreamed it would be denied!!! If I find out anything that can possible help the both of us I will sure let you know!!