Question:
Need info on anyone who was approved by a federal insurance plan for my appeal :-)

I've been denied twice by my federal HMO. Per their contract WLS is covered, but the HMO gets to decide what the medical necessity is. They are not following the federal guidelines, nor what other federal insurance companies are using for WLS criteria. My BMI is 47.8, high cholestrol (high LDL), back pain, knee pain, fatigue, shortness of breath, insomina,gallbladder already removed, small leak in heart valve, apple shaped, depression, low self-esteem, limited physical activity (obesity), possible thryoid problem, etc.... If you had WLS that was approved and paid for by a federal insurance company. Please e-mail me your name, insurance company, their criteria for WLS, date of your surgery, type of surgery, how long it took you to be approved. Plus anything else you feel will help me to achieve approval from my HMO. Thank you to Ray Hooks for suggesting that I show in my appeal that other federal insurance companies are approving WLS using the federal guidelines. Maurine    — Maurine S. (posted on December 27, 2000)

December 27, 2000
I had WLS 4/4/2000 and my insurance provider was BC/BS Federal. I had no problems in getting my approval, was done in a matter of days. If you have federal insurance you can call the Office of Personnel Management in Washington, DC they oversee the federal employees health benefit plan/programs . Your local personnel office should have the number. I'm sure they can help you, it's my understanding that not all federal plan offer WLS surgery. That is why I changed to BC/BS in 1999. You might also go to the OPM website: www.opm.gov/insure and see if there is any information that might help you. You did not indicate which HMO plan you have. I had an HMO prior to BC/BS and they would not cover my surgery. Good Luck and don't give up OPM can intercede on your behalf if necessary.
   — ann A.