Any luck appealing exclusions???

Texas Teacher

Has anyone EVER had any luck overturning a denial based on an exclusion? WLS is excluded by my insurance, but I have appealed on the grounds that I am NOT having the surgery to treat my weight, but I am having it to treat the MULTIPLE co-morbid conditions I have. Do I have a shot in the world, or am I beating a dead horse:deadhorse:?

Thanks for your input!

__________________
Renee
Richmond, Texas

PLAN "A": Scratched due to insurance
ON TO PLAN "B"::clap2:
Dr. Jose Rodriguez
Acuna, Mexico
Tentative Date: 06/04/07

dolphin_dreams

I don't have the answer to your question but I wanted to offer some supports from one Texas teacher to another. Good luck!

__________________
Banded on 11/08/2005
Dr. Veninga: Carrollton, Texas

247/170/140 goal

Texas Teacher

Thanks for your message! I know that the liklihood of me actually being able to overturn the denial is pretty much zilch, but it sure helps to know there are people out there actually listening. I also know that I will not be able to have the surgery without the insurance, so it's going to be pretty depressing when I get that final denial letter.

Thanks so much for the support and understanding!

__________________
Renee
Richmond, Texas

PLAN "A": Scratched due to insurance
ON TO PLAN "B"::clap2:
Dr. Jose Rodriguez
Acuna, Mexico
Tentative Date: 06/04/07

DrC

Renee,
We have not had much luck with people beating exclusions. If you want to have any chance at all I'd recommend hiring a lawyer, like Walter Lindstrom, who specializes in this stuff. I think his web site is www.obesitylaw.com

Good luck,
Dr. C
Cincinnati, Ohio
www.TheBandDoctor.com 877.442.BAND
DISCLAIMER: I am not your surgeon, any comments made by me are not meant to be taken as medical advice, just general guidelines. Contact your surgeon about your specific problem!

Texas Teacher

Thanks! I have considered consulting with an attorney, but I wanted to say that I honestly had given it my best shot before I spent the extra money knowing that I STILL might lose. Unfortunately, money is the issue in the first place, so I'm not real excited about the idea of trying to find more. Now, if I could just find that ever elusive money tree I have heard of...

__________________
Renee
Richmond, Texas

PLAN "A": Scratched due to insurance
ON TO PLAN "B"::clap2:
Dr. Jose Rodriguez
Acuna, Mexico
Tentative Date: 06/04/07

Texas Teacher

Well, I received the second denial letter. I expected as much, but it sure didn't help the feeling of depression when it arrived. I'll probably go "underground" at least for now since I know there is NO way for me to do this without the insurance.

Thanks for all the encouraging words and advice!

__________________
Renee
Richmond, Texas

PLAN "A": Scratched due to insurance
ON TO PLAN "B"::clap2:
Dr. Jose Rodriguez
Acuna, Mexico
Tentative Date: 06/04/07

~Jules~

I would suggest contacting your HR person. The exclusions are done by the employer to get cheaper rates. I didn't fight it myself because I didn't want to wait, but I had two people here at work that fought it in order to get the gastric bypass done. They did it together. But, they are V.P.'s with the company, so that could have made a difference too. Who knows. But I would at least talk to your HR person and see what he/she has to say about it.

Good luck.

__________________


banded 10/26/06
260/203/165
5'11"

myturnow

I went to obesitylaw.com and checked it out.. it says approx. 90% of denials are overturned... I am paraphrasing.... but that is the route I am taking.. do what you need to do.. donnaco myturnow