My Insurance Company is absurd!!

Well I have now been turned down a second time for the removal of my grade 5 pannis.  After being turned down the first time, I got letters from my family doctor, weight loss surgeon and my plastic surgeon explaining the health risk this large hanging blob is effecting my health.  The insurance company was even sent some very graphic pictures along with all three letter.  I also included a personnel letter explaining how this was effecting my health and daily life.  Their whole decision is based on one line in a 30 some page policy (no surgery is included for weight loss). Meanwhile I get phone calls from their nursing staff to see if I am living a healthy life stile and trying to improve my health.  So I have lost a total of 220+ pounds from the start, off insulin and most of my meds, but I guess weight loss is not something they feel is improvement.  It doesn't matter if I lost it with WLS or on my own, they still would not cover it.  Oh by the way I am talking about Humana.

Has anyone  gone through this before, any ideas on getting through to them? My plastic surgeon is going to try and call the insurance company's doctor who denied me and convince them to cover it.  I know I am ranting but this whole process with the insurance company is insane.  Thanks for listening.

That stinks. A good rant is in order. Sounds like you have good doctors though that are willing to go the extra mile. That's a plus. Good Luck!

Thanks and congrats on you loss so far, keep after it!

I work for one of the large insurance companies (not Humana) the problem is the insurance company is just the administrator for your employers health plan, more then likely your employer has a self funded plan (meaning your employer is actually funding every claim). 

I said that to say your employer has made the decision to exclude certain things from coverage (even if they are medically necessary). The majority of employer plans don't cover weight loss surgery or conditions arising from them. I just wanted to explain that to say, this is clearly medically necessary for you, but if your plan specifically excludes it, then it will be difficult to get this approved. 

Sorry about that.

I appreciate you comments.  But you have to admit that having their staff contact me on a regular basic and congratulating me on the good work of loosing weight, getting off insulin and meds and greatly improving my overall health is contradictory to their position on a possible serious health issue.  The elimination of the cost of insulin alone would pay for the procedure in about 1 year.  I don't need words of encouragement from them, I need a realistic position on a known fact that comes along with my kind of weight loss.  Again, thanks for you input........just need to vent.

You may need to be prepared that you may have to self pay for the skin removal. A lot of us needed to do that. 

Ya, you are probably right.