Question:
What do you do when they say it is not a covered benifit?

I was denied a consult to see a surgeon for wls because it was not a covered benifit. What is my next move? Do I appeal or try a different PCP? One who has had more experience in writing a referal for wls with my insurance company. I am at a stand still right now and don't know where to turn. Your suggestions are much appreciated.    — Patricia A. (posted on September 1, 2000)

September 1, 2000
I guess first you should call your insurance company, the benefits line and ask if Gastric Bypass surgery is a cov. benefit under your policy. Then ask them what the criteria would be. Good luck.
   — [Anonymous]

September 2, 2000
Try calling your insurance company to see if it's a covered benefit. If it is, you may have to change PCP's to get a referal. I had to do that. My first PCP said that he had never had anyone approved that didn't have comorbidities (he said the arthritis in my hip didn't count as a co-morbidity). After researching further, what I found is that sometimes your PCP will limit your access to the surgery because the physician's group won't approve the surgery, not because the insurance won't approve it.
   — Gina E.