Question:
insurance denied......any other suggestions??????

I have recently been seriously inquiring about this surgery, and i called my insurance office and they advised me that i would have to have the surgeon sent them a letter with the medical necessity of the surgery and they would either approve it or decline it...Well, today i called a surgeon and his nurse told me that i might want to check with them to see if gastric bypass is an exclusion on my plan...Unfortunately, it is, and now i'm not sure where to go from here, because i really had my heart set on this...i have heard other people mention state rehabilitation commission, but i'm not sure who to call about that one...if anybody has any additional suggestions or how i could contact someone on this rehabilitation commission, i would really appreciate it...thank you!!!!    — jennifer P. (posted on July 2, 2001)

July 2, 2001
Don't do what your insurance company wants you to - which is give up. I had an exclusion too but if you qualify for this surgery, it is considered medically necessary and they will cover it. It will take some fighting but it's well worth it. Read my profile to see what I went through and I can send my letter that got me approved with no formal appeal process. Best of luck & don't give up!!
   — Lisa B.

July 2, 2001
Jennifer...your post doesn't mention who your insurance carrier is. Look for others here who have experience with the same company. They can help you navigate the maze to get an approval. Your work is just beginning. The information is all available to you on this site...you just have to start digging it out. Don't give up. Best of luck to you.
   — Anne G.

July 2, 2001
My insurance had an exclusion also. I immediately asked how to appeal. I was required to write a letter explaining all my co-morbidities and my PCP had to write a letter also. It helped -- I got approved at 50%, which isn't great, but it's better than nothing!! Don't give up the fight!!
   — Brenda V.

July 2, 2001
I agree with the first post. When I called my insurance company they told me it isn't covered by my policy. But, I finally found someone else they did pay for it for. Don't give up just because they "said" it was an exclusion. By the way I am in a union. And since they paid for it once that supposedly means it sets a precidence and they HAVE to cover it for anyone else until it is a word for word exclusion. Because, my insurance is negotiated with my contract. Good Luck.
   — [Anonymous]