Question:
How can a company authorize de to medical necessity..then say it is not covered?

I jumped through all the hoops, got insurance approval for the procedure, now my HR rep told me to get a predetermination of benefits because as far as she knew it was not covered. My insurance states that it is not covered unless there are life threatening conditions that could be improved by significant weight loss. Isnt that what medical necessity is ? I tried to call the insurance company, but of course they had to research it and never called me back. Has this ever happened to anyone and do you think I have a chance of gettng the surgery?    — Lynda D. (posted on January 10, 2003)

January 10, 2003
JUST A COMMENT....I'm in the same boat. I was told that it had to be a medical necessity and once I got the okay from the ins. co. the employer says... "it's an exclusion." I looked in the Benefits book they recently gave to a new employee and it's not in there. I asked for a copy of the exclusion and they sent me the page... but this page is not in the book. So now I have to write a letter to the Benefits Committee to try and get them to change their minds. When I had called the ins. co. they said it was covered, when I talked to HR and she called the ins. co. she told me it was covered!!!! It's a never ending circle but you must plug on.
   — MICHELLE F.