Question:
Healthguard HMO does not cover .WHat are my appeal chances ?

I work for a medical center that has Healthguard HMO. Gastric Bypass Surgery is listed in their provider book as needing pre-authorization, however, my employer does not have the level of coverage for this. This procedure is excluded in their paln of coverage. What is my chance that their decision will be overturned by an appeal ? Besides the weight issue, I have sleep apnea,hypertension, and have had (2) back surgeries and (1) knee surgery. Has anyone had any success with getting Healthguard to approve on an appeal ? Please help. Any and all suggestions would be greatly appreciated. (ALso, I have had all pre op testing completed by a former insurance that I had with a previous employer).    — Christy S. (posted on January 14, 2004)

Sorry, no answers yet. Perhaps you have one to contribute.