Asking for advice again

Hi, I am just re-posting in the hope someone will offer some advice on the issues I raised below. I just need to know if an insurance company that knows it will not be a carrier next year, and knows that WLS is excluded next year, can use the appeals process to run out the time so that they do not have to pay for surgery. Is there any accountability for them if it can be shown they are doing this? Anyone with further questions can read my longer and more detailed post below. Thank you for any help.

You would need to really look at your plan and see what type of time they have to respond. 100% yes in my opinion an insurance company will do what it can to delay, stall or deny. So, you need to know exactly what they must adhere to and hold them to it. For example if it's self funded the carrier has 60 days to respond or they must ask for time in writing. Find your policy book and read it. You should be able to find out what they must do. That said, if the deny you and you appeal and they are reversed at some point, you can hold them to that reversal even if the new plan excludes the surgery as the appeal was based on a decision made during a time when it was covered. Good luck

I have done a lot of research on the plan and they have 10 working days to acknowledge, and 20 to investigate, then have to notify in 5, although they can ask for an additional 10 days if needed. The same time frames apply for the second appeal, and then I could appeal to the state board or the Dept of Insurance. As I did not find out about the change in the exclusion until Sept 20, when the new plan book came out, this makes it pretty easy for them to run most of the time out with denials, even though the doctor has gone out of his way to help and I have provided everything I know of that they could possibly need. If I had an approval, I could do the final things (psych, dietician, phys ther) within a week, but can't do them before the approval or they will not pay. The doctor has said he will try to help get it done in time if the approval comes in. Not only did the exclusion change, but GHP will also not be a carrier for this plan anymore, so that's where I was really worried. Can the Dept of Insurance make them pay after their coverage expires, regardless of the exclusion? How airtight is the exclusion that excludes "surgical intervention for obesity"? Thanks for your help! BTW, this is in Missouri.