Denied!!!

kim2bhealthy · March 10, 2006

Well, after waiting almost 4 weeks for my surgeon to submit my info to my Insurance, I called Tuesday to see if they had received it, they said "Yes, it was Denied". I said "When did you receive it?", "Today" was the response. Geez they didn't waste any time did they? I knew it would probably get denied because they have an exclusion in my policy that states " Surgical treatment and associated care for treatment of obesity" is excluded. I'm hoping that I can get arround this exclusion due to the fact that my diagnosis is NOT Obesity (Dignosis Code 278.0), but Super Morbid Obesity (278.1). Anyone else have this issue? Is it worth the fight? I immediately filed an appeal and will be bombarding them with documentation. I'll probably appeal and couple of times and if that doesn't work, I'll be a self-payer. Any suggestions?

:help:

Mita · March 10, 2006

I am Sorry but keep your chin up and keep up the fight. What Insurance do you have? Do you have Co morbidities? Does the exclusion change if you did?

3loves · March 11, 2006

Hi kim2bhealthy ~ Terrible news on your insurance! :confused: I am not able to offer advice in that area....I am still waiting on insurance myself and don't have much insurance experience....sorry. :phanvan They sound harsh to me, but I do know they can be the most difficult hurdle to overcome. :faint: Hang in there and do some research here with the word "insurance" and you will find advice in more areas than just the "Insurance" forum. I've read some interesting info from "Alexandra" (user ID) and she does seem to have quite a bit of knowledge around the insurance world. There are many others as well. :eek: I wish you the best.

On another note, glad to hear your a Nascar/Jr fan! :clap2: While watching Trackside tonight, I thought I should start a Nascar thread. :biggrin1:

kim2bhealthy · March 14, 2006

Thanks for the responses guys! Bubba-I have John Deere Choice POS insurance. I have several co-morbidities.. hypertension, sleep apnea, GERD, etc. My policy just states: "Surgical treatment and associated care for treatment of obesity" is excluded. That's it, nothing about being medically necessary or anything. I'm currently gathering info for my appeal and just yesterday received my official denial letter and appeal for from John Deere. Thanks 3loves, I'll do a search and see what I come up with. Go Dale JR!! What's up with Tony this year? He seems to battling demons from a couple of years ago! Where's last year's "Mellow Tony"? He's still my number two man! Later!