Exclusion of Service?

[EmilyIsSleeved 6]

I have been going through the process of getting insurance approval through BCBS of MN. I just finished my six month supervised diet, psych eval, etc. just to get a denial call today. The reason for the denial was exclusion of bariatric surgery services. The insurance company told my surgeon's office that starting January 1st of this year that they changed the policy to exclude bariatric surgeries. I wasn't even aware that the policy was changed until my surgeon's office called me today saying insurance wasn't going to cover any bariatric procedure. My question is that since I started meeting with my surgeon and my dietician prior to this change (I started seeing them in October 2010), is there a chance that I can file an appeal and win? If anyone has had a successful appeal of a denial based on exclusion of services, I would love to know how you went about your appeal. Thanks for all the help!

[snowfie9 6]

It never hurts to file an appeal. IT's a sad truth that sometimes you really have to be tenatious to get insurance companies to do what they should. Insurance companies bank on people not fighting for their benefits.

And if they deny the appeal, you appeal again, at least 3 times.

Good luck!

[Stacy160 201]

The word "exclusion" sounds like it's not the insurance company not covering bariatrics at all, but rather your policy itself not covering it. If that's the case, then it's your employer who elected NOT to include it in the policy, to save money, and in that case there's nothing you can do, unfortunately.

[Tiffykins 673]

Stacy is dead on with this one. It's not the insurance company that necessarily excludes bariatric services, it's the policy itself that was chosen by your provider/employer.

Unfortunately, the appeal process will be futile if the insurance policy has the exclusion even if you started the process before the exclusion became effective.

[Beadingnurse 116]

I have worked in insurance pre-authorizations before and I agree that if your employer has chosen to exclude weight loss procedures; you won't get anywhere with an appeal. The reason is your employer does not want any exceptions or they have look at them for everyone. Not encouraging news I know. . My insurance also wouldn't cover so my procedure was done with self pay. It is worth ever penny to me! Ask your surgeon's office if they have any financing options. Good luck!