Has anyone else had issues with ins. not wanting to cover when you clearly qualify? My case is now with the advocates. I was wondering if anyone could share their experience with them so I might know what to expect.:thumbup:

My doctor had me use the Obesity Law & Advocacy Center also but they were not helpful in my opinion. I don't know if the breakdown of paperwork was my doctor's office or the Law firm but my insurance denied me twice with their "help".

I asked to see what they sent to my insurance company after the first denial and it wasn't all of the information I had given to my doctor's office. I re-submitted my other doctor's recommendations for the surgery, my personal trainer's notes, etc. but they either felt it wasn't important or they didn't put forth the effor to submit them the 2nd time either. The second time I was denied, the insurance company United Health care informed me that I had no more appeals.

I ended up paying for the surgery myself. I wish you luck and hopefully your experience will be a better one.

Yes I went to them after the first denial. They were very helpful for me, and I was able to get mine covered through a program so I didn't have to pay. Let me say this is not a quick process and you won't always like the answers you get back.

In the end what happened was my denial was reversed however then the insurance co. said no longer covered as of the first of the year. Obesitylaw through persistence and getting in touch with the right people was able to find out that this was not the case. I would have given up on my own. In fact at times I was resigned that it wasn't going to happen. Not only did they help me but the specialist with my insurance was looking at other denials based on the wording in the insurance coverage so it is possible that my victory helped others. I can only say, if not for Obesitylaw.com this would not have happened for me. I am scheduled for the middle of March for my surgery.

Best of luck in your journey!

M

Thank you both for sharing! I had never heard of this before my surgeons office referred me. It is great to hear about others' experiences. I can not ever be a self pay, and I really need this for health reasons, so I will certainly keep at it!

Just make sure if you are using them, you have been denied for something other than WLS being an exclusion on your policy. If you have an exclusion on your policy for WLS, that is REALLY cut and dried and nothing a lawyer can help you with. You can appeal that until you're blue in the face and all you will have is a lot of wasted time.

Just make sure if you are using them, you have been denied for something other than WLS being an exclusion on your policy. If you have an exclusion on your policy for WLS, that is REALLY cut and dried and nothing a lawyer can help you with. You can appeal that until you're blue in the face and all you will have is a lot of wasted time.

I began this journey in August 08. In Sept after many calls to the insurance company they provided me with a letter stating what the requirements were for WLS. 40 BMI or 35 plus comorbities. My BMI was 37.4 in addition to the following diagnoses: sleep Apnea, hypertension, high cholesterol, and hypothyroidism. I completed all requirements, returned to my surgeon 15 Jan 09 and was denied on 22 Jan due to the change in the policy as of 1 Jan.

Today, is the first day I have been able to think about the situation since the denial. Do you think I have a chance with an appeal? Thanks for any information.

Leona

Edited February 16, 200917 yr by lisw55
Left out pertinent info

I began this journey in August 08. In Sept after many calls to the insurance company they provided me with a letter stating what the requirements were for WLS. 40 BMI or 35 plus comorbities. My BMI was 37.4 in addition to the following diagnoses: sleep Apnea, hypertension, high cholesterol, and hypothyroidism. I completed all requirements, returned to my surgeon 15 Jan 09 and was denied on 22 Jan due to the change in the policy as of 1 Jan.

Today, is the first day I have been able to think about the situation since the denial. Do you think I have a chance with an appeal? Thanks for any information.

Leona

Do you qualify based on the NEW qualifications, but since you were showing your qualifications based on the OLD required qualifications, maybe some things were left out of your submission? Or, maybe you are only short a test or documentation of something still left to do? Go on your Insurance company's website and print out the qualifications for WLS. If there is something you can still do, try to get it going ASAP and be sure to notice the time period in which everything must be done. For example, my 6 month doctor supervised weight loss program must be completed within the 12 months prior to my submission for approval. Good Luck!!:rose:

I was denied by BCBSIL and my case was accepted by the Obesity Law firm. I have recieved my case acceptance letter but have not heard from them since. I am hoping this will be my final step to getting approved as I started this long journey 1 year ago.

Has anyone else had issues with ins. not wanting to cover when you clearly qualify? My case is now with the advocates. I was wondering if anyone could share their experience with them so I might know what to expect.:thumbup:

Finally, Finally, Finally!!!!!!! Got my approval letter today!!!!!!:w00t:

Congrats!!

My Drs' office sent my case to them when I got my original denial. It only took 3 weeks and I was approved. They were more than fantastic to work with and I praise God for them. The work they do for us is priceless. God bless them

Just Tired