Question:
Denied today, will appeal. Desperate for advice, info, help, PLEASE!

I was denied because of an exclusion. here is the letter i recieved from Ins: "We have received a letter requesting Gastric Bypass Surgery with Laboratory Testing under the diagnosis code of 278.01. I am sorry but this would not be a covered expense under the plan guidelines. The Plan excludes surgical procedures for the treatment of Morbid Obesity or any complications arising therefrom to include, but not limited to Mason Shunt,Banding,Gastroplasty or intestinal bypass. Medical weight programs and counseling are not covered." Based on that is there any hope for me? What can I do? Is there ambiguous wording that i can perhaps get around? I plan on fighting them! I am piecing together an appeal, and need all the help and advice I can get on it. I desperately need this surgery; I'm 17, BMI:55, in pain constantly. The insurance is through my parents work. Please help! Thank you so much    — amie (posted on July 10, 2002)

July 9, 2002
Most policies have an exclusion about the surgical treatment of obesity, but unfortunately, your policy actually uses the words "morbid obesity." My opinion: you're fighting a losing battle. I would change jobs and get a new insurance plan if I were you.
   — Terissa R.

July 10, 2002
Mandy, I agree with Terissa. I would probably find me another job as well since this company was specific in addressing "Morbid Obesity" as an exclusion. Doesn't it make you mad that people are so inconsiderate and unconcerned about WLS? They probably wouldn't be if it involved one of their family members. We've REALLY got to think about a NATIONWIDE PETITION or something to the United States Congress or higher if need be about these type of denials for ALL of us!!
   — yourdivaness

July 10, 2002
Thanks to you both!!! I agree with you Hadiyah (thats a really beautiful name, btw) this is downright unfair and will someday be illegal to deny a person such a life saving operation, I hope. About the job, I wish I could get one. But I can't. first being because I can not drive. I didnt even take classes last year because i'm just too big and its too uncomfortable. :( and unfortunately I live out in the country, in amish country actually, so i would need to travel upwards of 30 mins to an hour to my prospective job and i have no way of making that commute. I havent lost hope on the appeal, i actually just found 3 people on here who beat the exclusion with this particular insurance company.I hope i'm as lucky!!
   — amie

July 10, 2002
Try www.obesitylaw.com...low priced lawyer who has been through this and is expert at helping for a very low fee...you can email your info. and set up phone appointment for a quote...web site says usually under $500.
   — Amy S.

July 10, 2002
Read the Benefit and Coverages manual cover to cover and check to see if there is a "medical necessity" exception.
   — Tonya C.

September 5, 2002
Mandy, good luck with your battle. I wish we all could get approved with no questions asked! I am facing the same situation with United Health Care. Surgical treatment for obesity and morbid obesity are excluded. My surgeon feels that it is worth a try to fight the exclusion when you break it down into terms of money and how much it will SAVE them by paying for it. I'm also going at it by showing them I am super morbidly obese, not just morbidly obese! Hopefully we will both prevail and beat these dastardly insurance companies. I think I'll start that petition on a web site. That was a great idea Hadiyah!!! I'll get working on it.
   — SMG I.