Appeal denied->Now External Review

I called Anthem today and was advised that a letter was mailed out to me yesterday and that my appeal had been denied because of the exclusion under my insurance policy. My appeal was approx 248 pages long (whi*****luded the copy of the certificate of benefits and materials they gave me introducing the policy). What now? Can any of you please let me know anything else that I might need to include in the next phase which is the external review? All responses are GREATLY appreciated. Thanks, Beth

Update: Anthem is not allowing me an external appeal. They stated in their denial letter that 'this is the final determination of Anthem's internal appeal process' and directed me to request a review of my case from the KY Dept of Insurance. Do I have any hope here? Beth

I think you can get an external appeal through the KY Department of Insurance. I know I had to go through the MN Department of Commerce for my External Review. You can check out my profile for more information. --TJ

hmmm, maybe you should do what i plan on doing...get your own private insurance and use both!! your exclusion might be with your job

What private insurance have you found that will cover the gastric bypass surgery? Beth

i am going to be honest, i am currently insurance shopping but i was told by a nurse that Humana and United Health are still allowing the surgery. She told me that Kaiser does not cover it anymore though (and she said other places as well). I am leaning towards Humana though. I just have to investigate a little more and start using them (if i decide to get them) right away. Maybe you can call a Dr's office and get an opinion as well. What is there to lose?!?!?

well, i called Humana and was already declined due to my weight so this is looking good and this isn't what i expected so there goes that idea...... this really sucks...maybe there is a lawyer that help fight the exclusion

Check Diana Cox's later post re: appealing claims. There's also Gary Viscio, charges a minimal fee. Obesitylawyer.com. That's all he does. Insurance companies. Fern B.

I wanted to thank you so much for the link. I checked it out and added it to my favorites. I do have an exclusion but saw hope when i read that although complex it is still a possibility. I haven't started seeing a regular doctor but already called them to start what ever it is i need to do. I am determined. Its good to have the info though