Denied by the insurance company

Red wine lover · January 30, 2007

I just received word that the insurance company will NOT cover the lap-band. High-lighted in the denial letter was no surgery for MORBID OBESITY, under the heading Physical Appearance.

Well, I don't need the band for my physical appearance, I need it to live a better, longer life! sleep apnea, sore leg joints, border-line hypertension and possibly diabetes in the future are all good reasons to lose weight.

We're self-insured here at work, so I had a nice chat yesterday with the HR lady and she said she would see if we could get that procedure coverage added to the plan. I have no idea of the chances, but do know that will take 2 to 3 months at least, if at all.

End of rant, thanks for listening....

Bill :cry

Shelby · January 30, 2007

Sorry to hear this Bill - hopefully your HR person will be able to help.

Candle · January 30, 2007

Keep the faith.

Maybe your HR lady can get it added or your employer can purchase a rider to your current policy?

2-3 months isn't really that long to wait.

I just started a 6 month supervised diet because my doctor's office knows it's a requirment of the insurance company I am purchasing a new policy with. My current policy with BC/BS won't cover any WLS.

I'm not even 100% sure I'm going to be covered by the new company.

ReneBean · January 31, 2007

Is it your company that excludes the surgery? Or your insurance company?

Or have you just not documented Medical Necessity of the surgery well enough? I would call the insurance company first - to see whether they can shed any light on the details of the declination.

If the insurance company doesn't cover the surgery for ANYONE - you probably won't be able to do much. Likewise if your company has an exclusion in their contract with the insurance company - it will take something close to an act of God to change that.

In addition to talking to your HR dept - you should contact the insurance company to get clarification on this point. Who, exactly, is saying this surgery is for Physical Appearance - and why. Maybe you can send them more documentation on the severity of your co-morbidities.

Good Luck!

TracyinKS · January 31, 2007

BILL! That really stinks!

anonemouse · January 31, 2007

Yeah, I would see if you can get it covered because of medical necessity. If the surgery is not covered because it "helps your physical appearance", you should be able to appeal based on the fact that you aren't getting it for your physical appearance.