Gary - Isn't insurance a contract???

We pay the premiums and the insurance company puts in writing what their coverage is. How can they ask for extra requirements (diet histories, etc.) if they are not stated on the policy? If insurance companies deny surgery for some requirement that is not spelled out on their policy, Can they be penilized by the State Insurance Commissioner???

Well,that's one of the reasons why we're successful with appeals. There are many ways we use to attack the policy, but most important is that you know, just as you said, it is a contract that you were not asked to draft but was prepared for you. These requirements should be in writing, and even then we fight against them. You're right though, there should be no requirements, no exclusions. I can tell you that I have been handling these appeals for a long time, and I have not yet had one client come to me who did not honestly need the surgery. I understand the insurance company wants to keep patients from seeking a quick solution to lose 30 or 40 lbs. But that is what doctors are for. Also, you being from New York helps, we have very good laws here regarding appeals. But there is no penalty. Sorry. Be well Gary Viscio www.obesitylawyers.com

Gary, You state that NY has very good laws regarding appeals. What about other States, such as PA? Donna

Yes PA Has an independant review system if it needs to get that far. Gary

Thanks Gary, If I ever get my surgery I'm not sure how I could help others trying to fight for WLS but I would be willing to jump in, in anyway. Donna

What you are referring to our "extra-contractual" requirements, like the diet requirement. Insurance companies have "utilization review" standards for different surgeries. For example, if you wanted to have a hysterectomy, you would need to meet certain requirements that would need to be documented in your medical records. You couldn't just decide you no longer wanted your uterus inside of your body. Some states make it harder on us than others, by giving the insurance companies more latitude in their utilization review standards. However, as Gary stated, you MUST appeal these requirements, and fight with everything you have. It really is ironic. I'm watching the Evening national news, and of course, the "Obesity Crisis" is headline news, as it is almost every other night. Our society is going to have to change, and we are going to have to do everything in our power to change it. Write your US and state senators, and let them know how you feel about being discriminated in health care because you're fat. Keep your chins up... Roberta