Denial due to insurance exception
when I originally started the process for a WLS approval - I called my insurance BCBS of Texas - and they said yes we do accept the surgery with approval. So I started my process. When it was submitted to insurance - I was denied because my employer has listed any WLS as an exclusion. I've also found out that any weight loss medication is excluded. Is there anyway I can fight this? How do I do an appeal when it is an exclusion from my policy?
Check the policy and the wording of the exclusion as well as your States Law, many exclusions are very vague.
Gary
www.obesitylawyers.com
I checked the actualy policy and this is what it states in the exclusion section of my policy:
Any services or supplies provided for reduction of weight including surgical procedure, even if the Participant has other health conditions which might be helped by a reduction of weight.
There is a Law in Ohio that states no medical procedure can be denied if it is deemed medically necessary and ..but then there is clause stating that if it is an exclusion in the Insurance than the Law does not apply.
I feel like I'm caught in a vicous circle....