Weight Loss Surgery Foundation of America

Saving lives one grant at a time

How to appeal an Insurance Deniel

The Obesity Action Coalition has put together this wonderful set of documents to help
you understand and appeal an insurance denial for weight loss surgery.
CLICK HERE TO VIEW INFORMATION

10 Comments

  1. I employed with a company that has completely excludes any weight loss surgerys. Does anyone know if I can have my doctors try to have insurance cover it for health reasons.

  2. I have Anthem BC/BS through my husband’s employer and Anthem stated that weight loss surgery was exclueded from our policy something about there are only 50 plus employees that work for the company my husband works for. I am going to try to do an appeal on medical necessity. I have been to weight loss seminar and my primary care physician states that it is necessary for my health and well being that I have the weight loss surgery. I fall in the severly obese catergory and I have tried to lose weight and tried other programs but I have had no success. I have been overweight for 8 years now and my health contains to decline. I am so many medications for all of my health problems it sometimes is hard to keep up with it all and I am only 39 years old. I feel as though the odds are stacked against me. I cannot figure out why that the insurance company doesn’t seem to mind to continue spenidng out thousands of dollars to treat my medical conditions when I know that alot of them could be resolved or at least better with the weight loss suregery and I know for myself it would make me feel alot better about me. I depise myself when I look in the mirror or at a photo of the person that I have become and I am always depressed, have no desire to do things with my family, I don’t like to sho much anymore cause nothing I put on is going to make me feel in better about my on the outside or the inside. So yes please anyone can you tell why insurance companys act like this toward people who barely make it and need the most help.

  3. I have BCBS and they denied me for the surgery. i am 20 years old weigh 295 and have tyoe 2 diabetes and they said i dont have a good enough reason to have the surgery i appealed the denial and that got shot down as well. please if anyone has any options for me please help me. samhill_23@hotmail.com thats my email. please please please i am just ready to give up on myself.

  4. Hello everyone, all of the stories I am reading sounds just like mine. I am 34 and have been wanting WLS for over 7 years now. I am employed with a company that has BCBS (which says that the policy is and absolute exclusion. I have exhausted all options on how to get this surgery done. I have went to my primary doctor, who sent me to a cardiologist. Short story is they believe that if I do not get this weight off , that if something goes wrong it will be very hard to preform any surgery on me with my weight. I came on this website to get an answer but only to find that we are all on the same boat. Let me know if any one finds an answer, Luv Ya.

  5. I also have BCBS through my husband’s work and they also exclude ALL weight loss programs, both medical and surgical. How do you appeal something that is already spelled out in the insurance information? We have two children with special needs and I have severe depression as well, so we owe many thousands of dollars in medical bills and thousands in credit card debt from medical travel, etc.

    I have severe back problems probably due to my weight as well as severe arthritis (again mostly due to weight). I have severe sleep apnea and cannot even take a shower without pain. I can’t play with my kids, I can’t take them places. It’s like my life is just over. I’m only 39 years old.

    I DO have Medicare, but the deductible is over $1000 and then sounds like I”d have to pay for the radiologist and anesthesiologist and add the surgeon’s fees and Medicare will only cover 80% of allowed charges!

    I don’t know where to even start.

  6. I as well have BC/BS with exclusion of this surgery. I am currently fighting it thru BC/BS on medical review. I do know that BC/BS allows up to 3 appeals. I work for what BC/BS considers a small group under 50 employees. I was told by the iron curtian as I call customer service at BC/BS that if I were in a group of more than 50 they would cover it! Really is that not dicriminatory. Just because I would for a small group then I can’t have it. Even my employer wrote a letter on my behalf to say let her have this surgery etc… I have not heard a word from BC/BS yet. I hired a patient advocate to help me with this process and it has been quite a headache for me. I have letters from like 4 doctors all saying the same. They can cure my health problems with this surgery. The cost to them is minimal compared to what they have paid and continue to pay to insure me. If they don’t care about us then they should at least care about there bottom dollar. So, therefore it is more cost-efffective for them to allow surgery. This is on my mind daily. I feel as you all feel I wake in pain in pain all day sleep in pain. Feel bad daily my mind wants to do but my body won’t allow me too. This is horrible and too top it all off about a year ago now I was in ICU for 5 days. I almost died from this health which is directly associated too the weight. I am going on 60 days now since I submitted for review and during this time I have been sending weekly faxes inquiring. No response at all. I am frustrated to no end, I pay and have private insurance but then I find that if I was on Medicaid this would be covered! How more frustrating can it get. Accept I don’t qualify for medicaid I work. I am a single parent with 2 children in college and a X husband that has not worked in 3 years. I am doing my best to keep us all floating and I could do more work a second job etc… At this point I can’t do the simpliest tasks such as house work etc… Each day I feel I get more disabled. Any resolutions any of you have keep me posted.

  7. I have BCBS and they denied me for the surgery because the have a exclusion right in the policy. i am 37 years old weigh 380 and have so much pain in my back and feet that it makes it hard to live some times. I have been on every type of diet and pill know to man. I am at the point in my life that if I didn’t have kids I would rather be in heaven. I was told I would have to pay $14,200.00 upfront. I just have no way to pay that kind of money. I don’t know any way to get a loan with my credit after my divorce. Does anyone know of any other options out there? Please if anyone has any options for me please help me I just can’t do this much longer.

  8. I find it funny that BC/BS will pay for a penial implant but not gastric surgery. They wouldn’t even pay for my birth control and I wasn’t using it for unwanted pregnancy – I was using them for endometriosis which cost me a complete hysterectomy because it couldn’t be properly taken care of.

    They will pay for blood pressure medicine, asthma inhalers, prescriptions for aches and pains related to obesity…but god forbid they approve the gastric surgery.

    If I wanted a penis, I guess I am in luck. But, I don’t see how that will help me. I don’t understand the insurance business. I used to do referrals and precerts for a medical clinic and even advocating for patients wore me out. Anthem Blue Cross is the worse.

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