Question:
Has anyone appealed and won against their exclusion policy?

Hi I have Mutual of Omaha's First Choice PPO and they have denied me because of a written exclusion in the policy. Has anyone appealed and won?    — Micheal B. (posted on July 24, 2002)

July 24, 2002
Barbara Thompson's book "Surgical Weight loss" tells how to fight and beat that exclusion. It has a lot to do with documentation of BMI and co-morbidities. I suggest you read the book, it might help.
   — Thomas M.

July 24, 2002
I have the same insurance as you..... Thay turned me down twice. I have (had) congestive heart failure, GERN, asthma, angina, collius, insulin dependent diabets, high blood pressure, CPF..... all documented with specialists who each wrote letters for my appeal, to no avail. Please let me know the details of your appeal and how it woks out! (Because of the exclusion Medicare kicked in for my surgery.) Good luck!
   — Linda M.

July 13, 2003
Yes, I also had been denied coverage from Mutual of Omaha. It was a very distressful situation, but I have to say that after my first appeal, they approved coverage. It is very important to be persistant. They need to understand that you are serious about getting coverage and that you are not going to just "go away". You are paying them for a service and it is their responsiblity to live up to their end of the bargin. It is also important that YOU understand that YOUR getting approval is only important for you. The insurance company IS NOT YOUR FRIEND. Your approval is nothing to them. It is only important to you and those that care about you. They don't. For them, this is business. For you, it is personal. Request that your doctor support your appeal by providing more indepth information to Mutual. It would also be nice if he or she called and spoke with them. My doctor was very supportive and did both of those things. That really made a difference. And last, but not least, read the most current Yearly Brochure from the insurance company and ensure that you meet ALL of the requirments. If you don't have a manual copy available, there is a copy on their website. If you do this, there is no way that they can legitimatly deny coverage. Sometimes you have to go the "extra mile". I contacted the FDA in reference to the LAP procedure because that was part of their initial denial. Don't be afraid the challenge their decision.
   — Ce-Ce P.