Question:
What's next??? I have been denied by Ameri Health

I received my lovely denial letter today! I quote "We regard that benefits are not available for bariatric surgery. Treatment of obesity is not covered under this employer's contract". I called today and once again was told if it was medically necessary it would be approved. My BMI is 43.4. So technically I am more than just "obese" is that a correct assumption? Also should I do the appeal by myself or should I hire obesitylaw.com. Any recommendations would be greatly desired!!!! I have no idea what to do next!!!    — NJChick (posted on August 26, 2003)

August 25, 2003
I would appeal yourself first. Only use a lawyer when absolutely necessary. It may be a matter of adding a dr statement saying it is a medical necessity. But check your plan book to see if its not there. If the appeal fails, then get to the lawyer.
   — snicklefritz

August 25, 2003
Appeal.. There is no "technically" if your BMI is 40 or over your mobid obese. and the "denial" states "obesity is not covered'... YOUR NOT asking for surgery for 'obesity' your asking for 'morbid obesity' which is a DIFFERENT diagnoisis..... if nothing else.. with that 'wording' you would have 'room' to appeal coverage.
   — star .

August 26, 2003
Thanks for the info. I wrote my appeal letter, but, I am going to wait until I get the info from Walter Linstrom before I decide what to do next
   — NJChick

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