1st Appeal w/ BC/BS Onpoint Ins. Co. Denial upheld
My Ins. plan exclusion states "Services for weight reduction programs & gastric stapling for treatment of obesity." My Lawyer did an appeal for me with what I thought was an excellent appeal letter- "The requested procedure cannot be considered a weight reduction program or gastric stapling for treatment of obesity. The plan does not exclude surgery for treatment of morbid obesity or super obesity w/ associated co-morbid states. Then went on to state The Dr. diagnosed me as MO, w/ type II Diabetes, sleep apnea, etc., also described obesity & Mo as two diff. conditions w/ MO as typically defined as being 100 pounds overweight or a BMI over 40, and that my bmi was 58, and that procedure was a med. necessity. Just recvd. letter from Ins. co. denial upheld stating gastric bypass is part of a weight loss program and is clearly excluded, anyone w/ any suggestions what I might include in my level 2 grievance?? Thanks in advance for any helpful advice
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