Question:
Insurance says I meet the criteria but WLS is not a covered benefit?

Need help w/appeal.. I recieved my denial letter anbd the say that weight loss surgery isn't covered. I provided information that shows it's medically necessary...How else can I prove it's mediacally necessary w/o repeating myself. Do you think I should ask my PCP for a 2nd letter? SOOO IRRITATED! I did everything to get approved the first time around and here I am... OH and how many appeals do you get??? *Any help w/this would be very helpful!! THANKS!    — Snowflake48342 (posted on March 9, 2003)

March 9, 2003
OHHH And I had my employer send me the book w/exclusions.. States "Services principally for observation or diagnostic evaluation, physical therapy x-ray or lab tests, or reduction of weight by diet control with or without medication" This is the only exclusion weight related!! :O) And it says nothing surgery related!!
   — Snowflake48342

March 9, 2003
I called the insurance board in my state. They said in order to prove "medical necessity" more that one doc will definately help. For example, rhematologist, endoncrinologist, pulmonary specialist etc. They also said for you to "educate" your docs and tell them (in writing and verbally) why you feel the surgery is necessary, even to the point of writing the letter yourself and letting them edit it and put the letter on their stationery paper. I'm going to try to have the bariatric surgeon help me with a letter to give to my other docs-remember, they're all not "up" or "experts" on this surgery. God bless and good luck! From someone who just found out! You can e-mail me if you like at [email protected]
   — Mary J. G.