Scott and White Health Plan - any hope for denials?
I'm a member of Scott and White Health Plan. Last fall, I was referred to their Bariatric Surgery Program by my doctor. S&W requires a 6 month supervised weight loss program before surgery can be scheduled. When I contacted the health plan about coverage, they said you are covered now, but your coverage will end 1 week before the 6 months period is completed. I asked them why my coverage would be cancelled, they replied "that's what your employer elected". Well, I'm self employed and told them I was never given the choice over which coverage to elect. Anyway, I appealed the 6 month waiting period and asked for surgery before coverage for the surgery was lost. They denied my appeal, stating that weight loss surgery was too risky to be undertaken without the 6 month waiting period; but, that I could opt for self pay. Since that time, I have been diagnosed with hypertension and osteoarthritis caused by my weight. Can I appeal this denial with any hope of having my coverage reinstated? Can I prove that their denial put me at greater risk for more serious and life threatening conditions? Please help, I'm desperate.