Question:
How does a person FIGHT Insurance rejection?

Hello, To all of you loosers out there.I have some major problems with my insurance, I have been trying to have this surgery sinceDec. of 2002, my insurance wont even pay for my Dr. appointment for a consiltation. Although they paid 100% for me to have breast reduction in march last year, so they have the BIG pictures with me naked and Know I need this surgery. Yes i have tried everything (except hepnosis). please somebody tell me what to do. thanks melissa    — melissa K. (posted on March 29, 2004)

March 29, 2004
Several things: if your employer does not cover WLS (ie, there is a written exclusion that specifically states surgery will not be covered for any reason) then there is no way to fight that. If they have an exclusion just for weight loss (products, commercial diet centers, or exercise equipment) without mentioning "morbid obesity" you might stand a chance. <p> You need to call your customer service rep at your ins. company and talk to them. Ask if they cover gastric bypass surgery for treatment of morbid obesity. If they answer yes, ask for a list of requirements they need to determine medical necessity. It may be easier to have your PCP talk to them (if your's is open to WLS, some are not). If nothing else, I can tell you I had a PPO at the time of my surgery, and made an appointment directly with the surgeon - did not need a referral. I want to say I did not have to pay for the consult, but they may have included it with their insuranace filings. You may have to retain a lawyer - several different ones are mentioned on this site, do a search in the Library for names and contact info. <p> Good Luck.
   — Ali M