How can they deny insurance payment for a life-threatening disease?
Payment may be denied because there may be a specific exclusion in your policy for weight loss surgery or “treatment of obesity.” Such an exclusion can often be appealed when the surgical treatment is recommended by your bariatric surgeon or referring physician as the best therapy to relieve life-threatening obesity-related health conditions, which usually are covered. Insurance payment may also be denied for lack of “medical necessity.” A therapy is deemed to be medically necessary when it is needed to treat a serious or life-threatening condition. In the case of morbid obesity, alternative treatments – such as dieting, exercise, behavior modification, and some medications – are considered to be available. Medical necessity denials usually hinge on the insurance company’s request for some form of documentation, such as 1 to 5 years of physician-supervised dieting or a psychiatric evaluation, illustrating that you have tried unsuccessfully to lose weight by other methods.
Payment may be denied because there may be a specific exclusion in your policy for obesity surgery or “treatment of obesity.” Such an exclusion can be appealed when the surgical treatment is recommended by your bariatric surgeon or referring physician as the best therapy to relieve life-threatening obesity-related health conditions, which usually are covered.Insurance payment may also be denied for lack of “medical necessity.” A therapy is deemed to be medically necessary when it is needed to treat a serious or life-threatening condition. In the case of morbid obesity, alternative treatments — such as dieting, exercise, behavior modification, and some medications — are considered to be available. Medical necessity denials usually hinge on the insurance company’s request for some form of documentation, such as 1 to 5 years of physician-supervised dieting or a psychiatric evaluation, illustrating that you have tried unsuccessfully to lose weight by other methods.
Payment may be denied because there may be a specific exclusion in your policy for obesity surgery or “treatment of obesity.” Such an exclusion can often be appealed when the surgical treatment is recommended by your surgeon or referring physician as the best therapy to relieve life-threatening obesity-related health conditions, which usually are covered. Insurance payment may also be denied for lack of “medical necessity.” A therapy is deemed to be medically necessary when it is needed to treat a serious or life-threatening condition. In the case of morbid obesity, alternative treatments—such as dieting, exercise, behavior modification, and some medications—are considered to be available. Medical necessity denials usually hinge on the insurance company’s request for some form of documentation, such as 1 to 5 years of physician-supervised dieting or a psychiatric evaluation, illustrating that you have tried unsuccessfully to lose weight by other methods.
