Have you been denied?

I suggest to everyone that you go through the process even if there is no hope because Why let the insurance companies off the hook. They want you to disappear. It doesn't cost you anything. It costs them money to deny you. You have rights. This may change in the future. Someone is going to die or become seriously harmed because they could not get surgery and the employers and insurance companies will be sued. Then things will turn back, :angry: Appeal and if you are denied then appeal again and then go to the commission. It only costs a stamp and some time. Even if there is an exclusion and it seems fruitless it raises awareness for the issue. Remember we are here to support you. You can still be with us. Just my 2 cents adjusted for inflation here

I have to agree - use that appeal process. I work for a self insured company, so they don't have to play by certain rules, so contacting the insurance commission won't really help. My husband's RNY was denied at first - BMI less than 40. Not only did his appeal get him approved, the criteria for surgery was changed. Personally, if insurance plans pay for treatment of alcoholism, they should pay for treatment of morbid obesity. Both diseases can be looked at at as "poor lifestyle" choices. It's just that alcoholism is a widely recognized disease, and there is a lot of prejudice against obese people. Our plan specifically excludes plastic surgery as the result of weight loss surgery (thanks to a couple of people who messed this up for everyone else in the plan, last year.) I hope to have some reconstructive surgery eventually. I will probably be denied, but I plan to appeal. The other thing I would suggest - write a GOOD appeal letter. Leave emotion out, put all the facts in. We really hate getting "whiney" letters. the ones that usually get approval contain factual information, not a lot of "I can't play with my kids on the floor." stuff. I can tell you something else - Jack is right - the more they hear from you, the more likely you are to get approved. (The squeeky wheel gets the grease!) Do NOT be obnoxious and rude, but persistant. Don't have an "attitude" because you will turn people off, but if you are nice and not defensive, the people you come into contact with will be more likely to WANT to help you get approval. My $0.02 sense worth!