Question:
I have now recieved my denial for reconsideration letter (2nd appeal)

And I am going forward. The letter states: In accordance with Section 12(f) of your Summary Plan Description, health services and associated expenses for procedures intended primarily for the treatment of morbid obesity, including gastric bypasses, are excluded. Because of this exclusion, the question of medical necessity is not considered in our decision. If you are not satisfied with this decision, you or your designated representative may request a hearing, at which time we will review your Summary Plan Description. I say they should have reviewed the damn Summary Plan Descritpion in the first place. Then they would have seen the many loopholes I can fall into. If you read my profile you will see that the exclusion also states "they can do it if it is part of an authorized, monitored care plan" My question is "What is a monitored care plan?" Is that the follow up care the before care or what and does anyone have any suggestions on how to work this in an appeal letter?    — K T. (posted on August 17, 2001)

August 17, 2001
I can't give you an answer, but my company is self-insured and I know I am going to have a huge battle. Of course, the people on our insurance end are complete idiots. I just wanted to give you some encouragement and I hope and pray for your appeal hearing
   — [Anonymous]

August 17, 2001
self insured SUCKS!!!! Mine would not pay for mine, even after a threat from Walter, I found out in my state, Texas, they don't have to answer to ANYONE!! state/federal. I hope you have better luck!
   — [Anonymous]