Question:
How can I appeal if my company's insurance policy does not cover obesity surgery?

   — myno1son (posted on February 16, 2004)

February 16, 2004
I had the same problem. My company is self-insured and they use United Health Care. My company is a hospital. I first tried to go to the Human Resourse Department. I wrote them letters and had meetings with them. It did no good. I then had my doctor write a letter of medical necessity and presented it to my manager, her manager who is the director of finance and again to HR. The hospital does not choose to add coverage for this surgery at this time. Try with all your power to get information on the surgery benefits, a letter from your physician and anything else you can get together. Ask to meet with the HR department and anyone else that makes those decisions. If your company is self-insured they can choose to make an exception to their policy. I have not given up. I may have to change jobs, but I am not giving up. Don't you give up. If one thing does not work, try something else. Hopefully your management people are more caring and compassionate.
   — Terry Lynn W.

February 16, 2004
My best advice on this is to ask the insurance company to fax or mail you a copy of the exclusion list. See how it is worded. Sometimes it will say "obesity treatment" or "weight loss treatment" is not covered. This is generally not the same as "Gastric bypass for MORBID obesity." Sometimes you reach a person on the phone who doesnt know the difference or simply doesnt care to know the difference. Good luck!
   — weluvtv

February 17, 2004
I work for a company that has an exclusion contract for this type of surgery. My insurance company will cover the insurance, it's just my company that will not. I hired the Obesitylaw.com lawyer, Walter Lindstrom. I'm in the process of appeal right now, and just received a 26-page "kick butt" letter to the insurance company and then they have a month to respond and then the next letter is to my company and we go from there. I'd recommend checking out this firm. Both he and his wife had the surgery and seem very proficient at the process. good luck and if you have any more questions, just email me.
   — jenniferw

February 17, 2004
Try Walter Lindstrom at Obesityhelp.com! He is the best attorney in the business and will let you know if he thinks he can help.
   — xena28

February 19, 2004
I do have Walter Lindstrom, Obesitylaw.com, letter they sent me outlining his services if you would like, or you can go onto his website, fill in the short survey and they let you know almost immediately, if they can help you. Although they have a cost table, they will work on a payment plan with anyone to help get this surgery. Please email me and I can fax you the information.
   — jenniferw

Click Here to Return