Question:
What are the reasons Coventry gives for declining you?

I have Coventry also and would like to have this surgery.    — Toni E. (posted on March 21, 2002)

March 21, 2002
I'm not sure where the original question is about Coventry, but I am a former claims examiner for them and the reason they give is it is "not a covered benefit". It is specifically excluded in the handbook. Even multiple letters of medical neccesity don't do much good. I tried fighting with them about a year ago. My doctor, the surgeon, both sent letters. While they agreed it was medically neccesary, there was nothing they could do, as it is not a covered benefit. I'm not sure what state you are in, but I do know that in some areas, if you have a rather influential employer sometimes exceptions can be made, but I warn you they are vvveeeerrryyyy far and few between. If you can prove that you have and an acid reflux problem and it is a cronic condition, I do know they have paid for a bypass for that, but the patient was not morbid obese. It requires a lot of paper work and alot of appeals, I'm sorry, I've been in your shoes. I now work for a different company that has blue cross/blue shield, and they are going to pay for the surgery. I go for my first consult tomorrow. Good luck to you!!
   — Nikki G.

May 14, 2002
I am battling the Coventry battle now, I have been declined based on a policy exlusion. I am starting the appeals process now, but from everyone I've talked to and everything I've read... its not looking good :~(
   — Jessica B.