Exclusions and Limitations

hello, My insurance company's exclusions and limitations states that it does not cover gastric bypass surgery. At the end of the list of exclusions it states nothing will be covered if not medically necessary. Do I stand a chance in hell of getting it approved. I am going to fight if they send me a denial letter. Marsha

We called our insurance the other day. mine says WLS is excluded, but will be approve for morbid obesity a BMI of 40 or 35 with co-morbidities. We were told by the two companies that to meet the medical necessity, the only requirement is that the doctor submits a letter of medical necessity. Oner other thing, if the employer bought a policy specifically with a written exclusion regardless of medical necessity, then you are screwed. To find out, you call the number on your insurance card, and give them the company and policy numbers from your card, and the insurance person can pull the policy for your employer up on the screen and tell you if it was bought with a written exclusion or not, OR you have the kind of exclusion that mine has. According to both companies, we have an exclusion EXCEPT if you meet certain guidelines.... which I told you above. According to both companies, if we meet the exceptions to the exclusion, then it will be approved. I have been waiting several weeks and found out today, that the insurance co I have does the approvals by the surgery date listed on request, but my surgeon doesn't put a date until you get approval, so mine stays on the bottom until hades freezes over! Make sure they send yours with a surgery date even if it is only a fake date and they amend it after approval comes in.