Question:
Are federal insurance plans required to follow federal guidelines on WLS?

I am insured by Group Health Cooperative of Pudget Sound under the federal plan. I've been denied WLS because of no co-morbidities. My BMI is 43.6. Under NIH guidelines I qualify without having any co-morbidities. They listed in their letter I qualify for everything else but the co-morbidities. Any help on this would be greatly appreciated. I am working on my appeal letter and am going to highlight this area. I will attach letter from my PCP, Orthopedist (will only say surgery will benefit me cuz no visible arthritis) and my physical therapist. I am having a sleep apnea test after two days after this appeal letter is due into my insurance company. HELP! Thank you!    — Maurine S. (posted on May 6, 2000)

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