Ghp

January 6, 2006

GHP denied me!!! They say the surgery is excluded. Has anyone been approved with this situation?

Alexandra · January 6, 2006

Laney, an exclusion can be pretty hard to fight. But do you know whose exclusion it is, and why exactly it's excluded? Is this a company policy where your employer decided what would be covered, or is it a standard plan from the carrier?

If the former, you may be able to appeal to your company's decision-makers to make an exception for you. If the latter, you should find out exactly what is excluded and why, and perhaps you can fight that. Is it all bariatric surgery under any circumstances? Is it excluded for everyone even if medically necessary? Is it the band that's excluded but not RNY?

As you can see you need to ask a lot of questions before you know how best to proceed. Depending on the situation, lots of people have indeed gotten around exclusions. What more do you know about yours?

January 6, 2006

I was told by GHP that if it was medically necessary, it would be covered at 100%. A month later they say it is a company exclusion. They sent the paperwork and it is. I sent an appeal letter because I have the name of the lady who said it would be covered.....I am hoping. I don't want to have to pay out of pocket.