BC/BS of NE ppo denied

I contacted my insurance company a few weeks ago just to see if they covered wls. The answer I received said that "Your coverage contains an exculusion for treatment and monitoring for obesity or weight reduction, regardless of diagnois, including surgical operations". I contacted them again and requested a copy of my policy and asked if this was an employer exclusion or the insurance company exclusion. I recieved another letter stating that it is an exclusion on the employer contract with bc/bs. Then they went ahead and told me I could request a second and final appeal. I am wondering how they can call my inquiry an appeal? I haven't even seen a doctor yet. I was just making an iquiry to see how much of a battle it might be to get approved.

All BCBS policies state that it is not a covered benefit... the question is , does your policy state that ONLY if medically necessary will they approve it... If so, you will be fine... VAL

The customer (no) service rat that you spoke with probably didn't understand that you hadn't submitted a request for pre-authorization yet. They are so used to speaking to people who are already denied. Don't worry, an inquiry on a service not yet requested or denied doesn't count as one of your appeals. Personally, I think you have a damned good chance at approval, since the wording does not state "morbid obesity" which is an entirely different diagnosis for garden variety obesity. You may have to go through the whole process, but when you get to the external appeal, you will probably be approved. Fight the good fight! Roberta