How do I get the insurance company to pay

I went to the Doctors, and of course my insurance company denied me, I appealed the decision and I was still denied. Does anyone know how i can get approved, or do I have to see a lawyer. My Primary Doctor thinks that this surgery would be good for me, so its not a just because i want the surgery. Any Help would be greatly appreciated.

There's a lot of info that would help with these questions.
A) Does  your insurance company and or EMPLOYMENT company cover the surgery?  If either one of these do not, then there's not really much anyone can do, including lawyers.

B)  Just because your doctor thinks it's a good idea for you doesn't mean it's an automatic thing.  Have they written a letter of support?  If so, what kind of info was in it?  Comorbid factors (High blood pressure, diabetes, arthritis, depression, high cholesterol to name just a few),  your current height, weight, and BMI, medically supervised or unsupervised diets or weight loss supplements you have been on etc.

C)  If you have more than one doctor treating you for various things (a regular doctor, a cardiologist, a pulmonologist etc) having a letter of support from each or as many of them as possible could potentially help.   The letters should say the same thing as above.

Good luck - let us know what happens.

Your EOB or customer service rep should give you the reason for denial. Without the reason there's not much opinion to offer.
I see you are from NJ. Check with the state insurance commission.

My insurance company required pre-surgery guidelines that had to be followed in order for the surgery to be paid for - contact a customer service rep at your insurance company and (a) ask them if it is covered at all and (b) if so, what steps do you need to take in order to have the surgery.

Your doctor's opinion is worth something, but in order for Aetna to pay for mine I had to do a 3 month diet & exercise regime and document EVERYTHING along the way. I had to find a certified nutritionist and start seeing her - I had to join a gym and use a personal trainer - and I had to visit my PCP every month to document that I was following the guidelines required by insurance. Once I had done all that I was approved with no problem.

You also don't say how overweight you are - some insurance companies go strictly by BMI so if yours isn't 'high' enough they may reject you for surgery.

You definitely need to do some research - contacting a lawyer would be a last resort (and expensive) - so do some digging and some research with your insurance company. When I finally got a GOOD customer service rep from mine she explained everything to me and sent me a 32 page document that gave me the requirements, information and just about everything I needed to know about WLS.

Best of luck to you - Kathy

I  am 5'5 and weigh 290lbs i meet the guide lines but my insurance company denied me anyway, because the company I work for doesn't have that in there policy

Sadly if your company's insurance plan does not include any type of weight loss surgery there's really not much you can do about it. Its not like they're denying you based on anything such as weight, history, etc - they would deny anyone because they just don't cover it. I seriously doubt even a lawyer could help you in this regard - no company is required by law to offer WLS through their insurance - thankfully a lot more of them are starting to cover it but there are still too many that don't.

Every time your company has enrollment I would ask about it - they may change next time and decide to include it. Otherwise as long as you work there and are depending on their insurance to cover it you may be waiting a long time.

I'm really sorry to hear this - I thought most companies were offering it now, but then again it will make their premiums go up and in this day and age they're all looking for a way to cut back, and since being overweight/obese is one of the last 'acceptable' discriminations around they don't have to offer coverage for surgery if they don't want to.

You can demand a medical review with the Medical Directors at the insurance company.  You will have to get your physicians to submit all documentation to the medical director showing you meet the criteria for approval.  If you have more than on physician ie cardiologist, gastroenterlogolist, PCP, gastric bypass surgeon you will need the documentation from all of them.  Usually the surgeon's office will organize all that for submission to the medical director.  There are times when one or all your physicians might be requested to have a face to face with the medical review board at your insurance company.  Do you know the reason they have denied you, if so that would be helpful in directing you.  Don't give up after the first denial - keep fighting for what you believe.
Ida

the plan we have at work doesn't include any type of stomach surgery. I sent all the information in from both my pcp and gastric bypass surgeon and they still denied me

Even though they may have exclusions if you have some comorbidity like hart disease, sleep apnea, diabetes or high blood pressure you may be able to press the issue. call the insurance commission from your employers state.
Some times if deemed medically necessary you can force it but you will likely have to jump through  hoops.

A first level customer service person is trained to say no. You need to get higher on the food chain.