There is nothing that can be more discouraging than being denied weight loss surgery insurance. It is important to understand that if you've been …
There is nothing that can be more discouraging than being denied weight loss surgery insurance. For years it was held that these types of surgeries were cosmetic and alternative options for patients, and it has taken some time for insurance companies to recognize that this type of procedure is a necessary lifesaving mechanism for many people. It is important to understand that if you’ve been denied this procedure that you still have options.
Sometimes It’s Not the Insurance Company
While it may be a logical conclusion to blame the insurance company, in many cases when you have an HMO, the denial is out of the insurance company’s hands. The decision to cover these types of surgeries is usually decided by the employer at the time they purchase the insurance. Since bariatric surgery is not likely to be covered in the standard policy, employers must purchase a ‘rider’ to add to their HMO plan. The cost for this rider usually comes out of the employer’s pocket, so many will opt not to include it. If this is the case, then you should take this matter up with your Human Resources Department.
If You’ve Met the Requirements but are Still Denied
There are a number of reasons why an insurance company will deny your claim when you have met all of the requirements. Usually it is a matter of technicality; lost paperwork, delayed arrival of documentation, etc. If this is the case then you should ask your surgeon for a “peer-to-peer” review. This is where your surgeon meets face-to-face with the medical director of your insurance company to review your case and show exactly how you meet the criteria.
Hire an Obesity Lawyer
There are a number of different law firms that specialize in weight loss surgery denials. They are relatively easy to find through a number of different search engines that are designed to match you to a lawyer that can help you with your specific needs. These lawyers are extremely knowledgeable about all the details that can curtail an insurance claim and can expedite the approval process for you.
Short of paying for the surgery yourself, the insurance company is the only other option for getting your bariatric surgery done in a timely fashion. If you have been denied weight loss surgery insurance, it is important that you don’t give up but continue to pursue your case. Weight loss surgery, for many, is a lifesaving matter and it is a necessary procedure to gain control of your health so you can have a more promising future.