Question:
Denied for exclusion, anyone out their appealed and won?

I was recently denied based on the basis that it was not a covered benefit. The exclusion states"no treatment for obesity not due to organic causes." I am appealing based on a)there is an organic cause-genetics b) the should be terminology is wrong-it should say morbid obesity not just obesity c)the surgery is not for obesity so much as it is for the co-morbidities I have. They are: hypertension, gastric reflux, asthma, chronic venous insufficiency, peripheral neuropathy, and osteoarthritis is my neck, lower back, hips,knees, ankles, and wrists.    — cdonges1 (posted on June 17, 2005)

June 17, 2005
There is a web site that has a class action lawsuit to try an get these insurances to pay for weight loss surgery .You could look it up at www.obesitylawsuit.com.Or you can click on Main Entrance on the home page it will show you where to go plus answer some more questions. I hope this helps you out. Not sure if it will answer yur question but it doesn't hurt to look. Good Luck Patricia Stephenson
   — Patricia Stephenson

June 17, 2005
There is a web site that has a class action lawsuit to try an get these insurances to pay for weight loss surgery .You could look it up at www.obesitylawsuit.com.Or you can click on Main Entrance on the home page it will show you where to go plus answer some more questions. I hope this helps you out. Not sure if it will answer yur question but it doesn't hurt to look. Good Luck Patricia Stephenson
   — Patricia Stephenson

June 20, 2005
I used Kelley from Obesitylaw.com, she rocked. Please read my profile and if you have any questions, just contact me. (RNY LAP 12/17/05) six months out and down 81 pounds :)
   — jenniferw