Anthem Access of KY denies tests

How can I support an appeal if the insurance is denying me the opportunity for covered treatment for a sleep study, psychiatric & nutrition consult. The policy covers it, but Bridget S. at Anthem today asked me why I was requesting these services and I told her wls. She said that they would not cover the services and they would not cover the Gastric Bypass Surgery. The CSR's rudely argue with you. HOW can I do this without having supporting documentation. All I have is previous weight loss documentation and my BMI (50). For Anthem to approve wls on the policies in which they say they cover- the require nutrition & psych consults. What do I do? I can not afford to pay this out of pocket. Oh- and I explained to Bridget that the exclusion was related to Obesity and that Obesity is a total different diagnosis & code than Morbid Obesity, she said WE WILL NOT COVER IT! I explained to her that the exclusion did not say that and I would fight it all they way to the civil courts. She told me to go ahead and file a suit in the court because they will not pay. I hope to prove her wrong! Beth M

Beth, If those pre tests are covered then they should be covered, plain and simple. Don't ever rely on the word of these nuts who work for the carriers. It changes depending upon who you get on the phone. Have the docs call and see if the required tests are covered and let them deal with it. As for the exclusion, that is a different story and must be dealt with differently. Gary Viscio www.obesitylawyers.com

Thank you Gary!