Insurance Exclusion, is it worth the fight?

This is a really old thread so you may get a better response starting a new post.

If you have to self-pay for WLS, one of the best DS surgeons is Dr. Antonio Esquerra at Mexicali Bariatric Center. He's very well regarded and his fee is cheaper than a US or Canadian-based surgeon.

Thanks so much for replying and the suggestions.

You have given me hope.. I want stop fighting....

I work for a company that is Self insured as well, yet uses UHC as its plan administrator. Our insurance had an explicit written exclusion that specifically mentioned that it would not cover any WLS. I knew this going into it and informed my surgeon of such and the staff there started drawing up the appeal paper work. I was able to add a letter of recommendation from my gastro, neuro, and PCP, and was approved on my first appeal.

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???