Anyone have a self-funded insurance w/exclusion and fight it?

I just want to scream!! Why is it the insurance company skate around these issues?? How can they get away with denying coverage when it can be proven as medically necessary by 2 doctors with co-morbities just because THEY chose to write it as an exclusion? Is there no consideration as to the health and welfare of the living person behind the request. I don't understand. What's worse is never being able to get a direct answer on how to fight it or if it can even be fought! Add onto that the fact that the "insurance company" is acting as nothing more than in an administrative capacity because the "insurance" is actually paid by the employer because they self-fund the insurance is even worse! Anyone out there have a written exclusion that reads (similar) "Medical or surgical treatment or regimen for reducing or controlling weight, including morbid obesity" AND know that the insurance is a self-insured or self-funded plan? I don't know where to go from here. I've gotten 3 different stories from 3 different people at the insurance company. Forget about talking directly to the HR department at the company because I was advised (and I quote)...you would have to, more or less, be dying before they would approve you. WHAT A HORRIBLE THING TO SAY TO ME!!! Doesn't the fact that my BMI is 57 or that I have sleep apnea or diabetes and other issues be a factor for a decision??? I don't want to start the procedure without first getting pre-authorization. My PCP can help me obtain most of the pre-surgical testings because he can refer me to have them instead of the bariatric surgeon but I'm so confused, upset and MAD as all heck about this. HELP. Rose

We greatly appreciate your interest in helping us build our Q&A database. To discourage vandals from posting garbage, however, we require people to register before posting.

You must be logged in to post an answer. Click here to log in.