Denial

I just got a letter from my insurance provider saying that they have an exclusion in my policy and will not pay for any kind of weight loss surgery or treatment no matter the cause or if it causes a condition or makes a condition worse.I don't know what to do it says something about I could file a civil suit but what good would that do? I am so depressed. I'm sure I am not alone and that others have been here but it sure feels like I am. Most of the doctors around here don't even want you to come to a seminar without insurance approval forget about making an office appointment. Is there any other way to have the surgery and make payments or anything like that? I have tried everyway to lose weight but nothing works this is my last hope.

You need to appeal. Look at your policy and State law. Exclusions are not all they are cracked up to be. Gary Viscio www.obesitylawyers.com

Lisa, and EVERYONE working with your INSURANCE. I have 30 years of insurance experience. Get every thing you can think of into the appeal - problems with sleeping, moving, ability to work, any medical conditions, things aggrevated by the obesity. DO NOT GIVE UP until you exhaust every avenue and appeal. The ins. companies typically deny everything the first time if there is even a chance that they can get away with not paying. DO file an appeal with the ins. company and file an appeal with your state insurance department and anyother insurance regulatory agency you can think of. In Texas it is the the Texas Dept of Ins - do a google search for your state and send them an email with your info and then find out what all they need. My insurance, Humana HMO, listed any service for obesity, including surgery as a non covered service - which typically means they will not pay (the service was covered until 1/1/2004). I filed a case with Texas Dept of Ins at the same time as my physician's office filed with the ins. I got a denial letter from the ins. and then contacted TDI to see what was going on with them only to find out they had an APPROVAL letter from the ins. that documented a review by the medical director and a doctor to doctor consult!!! Once it was all cleared up (my denial was dated after the approval) they are paying for the surgery. There are also patient advocates and lawyers who specialize in obesity claims. I would try the advocates first as they are usually free. One I was considering using is PATIENTADVOCATE.ORG. I do not know anything about them but what I read on their website. SO DON"T GIVE UP UNTIL YOU HAVE EXHAUSTED ALL AVENUES. Get any and all doco you have to show how badly (medically) you need this surgery!!