Question:
I've been denied for the last time--What can I do now?

I have insurance through my employer in MD, which is a small group company. There is an exclusion in the policy stating that treatment of obesity or treatment for weight loss is not a covered benefit. I have appealed their original decision, which was denied. I then filed a complaint with the Maryland Insurance Administration, and was told there was nothing they could do, because weight loss issues are not a mandated service in Maryland. My local senator, who sponsored and had passed a bill legislating obesity treatment, wrote a letter to the company, only to be denied again. The legislation I referred to passed, but it did not include the small business plans. There is a plan that in July 2002, the insurance commission will include it in their plan, which would go into effect for me, but it would not go into effect until the policy is renewed in March 2003. I don't want to wait that long to have this surgery. I am missing out on so much now. Are there any ideas for me to utilize from here? I would greatly appreciate any input on this.    — Jackie L. (posted on June 28, 2001)

June 28, 2001
Talk w/ them about the next level? Perhaps get an attorney involved? I'm awful sorry I know what its like.. the situation is a hard one.
   — Dawn R.

June 28, 2001
This may not be what you want to do, but I ended up finding another job because of the exclusion in my policy. I just started looking at all the postings for the large companies in the area and sent in resumes. Was lucky to get in within a couple of months. Just another idea if your willing.
   — Angela B.

June 28, 2001
What about purchasing an individual health insurance plan? It could be cheaper than paying for the surgery yourself if you could find a plan that does not exclude WLS. If that didn't work I would look for a job at a company who's benefits cover the surgery. I like my job, my company, and the people I work with but my health is more important. If I am unable to get coverage under my current insurance, I will change insurance, even if that means changing jobs.
   — tammym

June 28, 2001
I had tyhe same exclusion and my insurance company tried to deny me but I let them know that the surgery is for MORBID obesity which is life threatening and when push came to shove they covered it because it was medically necessary. I have a letter you can try if you'd like. Insurance companies try all they can to discourage you but the truth is if you qualify according to NIH guidelines, refusing you treatment is discrimination and I w9uld threaten to use an attorney who speacializes in this. I was going to use Walter Lindstrom but luckily didn't need to.
   — Lisa B.