Re: Friend wanting to have WLS but has been denied by insurance

Hello everyone!!! I would like all of those who had WLS surgery and were denied once, twice, or more by their insurance company what avenues did you have go down and what procedures did you and your PCP have to go through in order for you to be finally approved for your surgery. I have a friend that wants to have the surgery but she is not getting much support from her PCP and also her insurance has denied her once. What should she do????

If she needs to change PCPs, then she should consider doing that to get the support she needs. If she needs a letter for her PCP to sign, I've got one in my profile she can "borrow" and use as well as one that I wrote myself that she can use. As far as insurance goes, it depends on why she was denied. If it was due to non-coverage, then she'll probably need a lawyer to advise whether she can fight for coverage and if it's just that she didn't submit things correctly, or give enough information, or have a 6-month physician supervised diet, then she has work she needs to do before appealing. Basically, it's hard to answer your question properly without more specific information, but I wish your friend good luck! Insurance companies can be difficult at best. Jan 240/128/115 (at goal size)

First thing what are the exclusions? She should appeal appeal appeal if it is a covered item. Her case has to be rock solid and it has to be Medically necessary. What insurance does she have? Is it self funded? Sherri