Insurance Exclusion, is it worth the fight?
My company has any weight loss treatments or surgery as being excluded from our insurance plan. If it's an 'exclusion', is it even worth filing an appeal? It sounds like it's my companies decision to not cover the surgery to keep insurance expenses down for everyone. Has anyone had success in appealing an exclusion? If you were successful at appealing an exclusion, would you mind sending me a sample of the appeal letter?
I've decided that I will self-pay if I can't get insurance to cover it.
You can appeal to the insurance company, it will likely get denied. The 2nd appeal is usually directly to your employer since it sounds like they are self-insured.
Good Luck. It's worth a try.
If they say no, you have your answer and join the ranks of self pay! Its worth it though.
This is the first time that I've felt confident that self-pay is going to be worth it for me. I go to a seminar on Thursday, so I want to ask questions about the self pay.
I'm SOOO encouraged by the information on this board and the amount of information that everyone is willing to share. I've been so very depressed lately that this is one thing that I'm actually getting happy about. So, thank you all !!!!
The self-insured companies kill me!!! They add and substract benefits when it's convenient for them. Usually some big wig in the company needs or wants something and it's magically covered, then gone!
You're worth it! And so is this surgery. It will be the best investment in yourself you'll ever make! And you won't have to deal with the insurance B.S. and play their waiting game!!!!
There is also a Dr. Forse at Creighton now who does the DS, but I haven't heard what the self-pay rate would be there.
I My DS
SW/263 CW/136 GW/150
on 7/29/15 8:57 am
Hi, I called my insurance today and they said wls is listed as an exclusion, so what should my next step be? I am just starting this process, calling the insurance was the only thing I've done so far just not sure where to go next.
The reality was that the appeals board that handles our company, was able to clearly see and quickly justify that the 20k or so for the DS was going to be less expensive over all than the possible long term health issues I was facing in the near/immediate future.
Never say never, Appeal away, what is the worst they could tell you, NO???
HW: 372lbs. SW: 358lbs. Goal: 180lbs. CW: 165ish
Pants: 54 to 32 - Shirts: 4x to Med - I My DS!