WLS not a covered procedure according to Insurance

Spring V.
on 10/1/03 5:59 am - Chester, PA
Hello everyone, I've been around this site, for about 6 months. Studying, learning all of the ins and outs, pros and cons of WLS and have decided it will be the right procedure for me. I met with my doctor, we went over my history, and he was very impressed with the knowledge I have gained about WLS. He and I agreed this is my best option. Soooooo - I go home to call my insurance company. My husband works for Acme, he is in UFCW Local 27 (Southeastern PA, DE and MD), with benefits administered by UFCW Local 56. Our health insurance plan is Horizon Personal Choice of NJ. Here is the problem - with most plans, they will cover the WLS. However, our fund office states it is not a covered procdure, even if deemed medically necessary (BMI = 40 with comorbidities). So my question is - has anyone successfully appealed a denial because the surgery isn't covered? I mean has anyone had success in forcing their insurance company to pay for WLS? All suggestions would be greatly appreciated. Spring - Delaware County, PA
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