INSURANCE DENIAL - PLEASE HELP!

Tami G.
on 9/3/04 2:50 pm - Leavittsburg, OH
I am being denied coverage for the RNY surgery by my insurance because of an exclusion clause in our policy for treatment of obesity. I have already sent one appeal and am still being denied because of this clause and "not having coverage benefits". EGP is my insurance administrator. Can anyone recommend an insurance company in Ohio or PA with coverage in Ohio and PA (if one exists) that I can purchase myself and not go through the hassles of pre-existing or waiting 6 months for a medically supervised diet? All of the insurance companies I have looked at online contain pretty much the same type of exclusion clause as my employer policy does now. Although I plan to try and have my employer get more involved to appeal this clause in our policy, are there any other recommendations for those who have gone through this also?
koogy
on 9/3/04 11:00 pm - Cincinnati, OH
If your policy excludes treatment for obesity, that is not the same as treatment of MORBID obesity. If you currently have insurance and they have other criteria that must be met, you are better off to go ahead and do whatever is needed to meet that criteria. This surgery is not something that you can get to instantly. I know it's hard to wait, but there are people who have had to wait months and even years to have surgery, so you must be patient. My insurance does not have any exclusions or other criteria with supervised diet requirements, but it took me 9 months from start to date of surgery to be scheduled. Take care, Sue
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