Question:
I was denied by Kaiser Permanente in Maryland. How can I appeal?

Kaiser wants me to demonstrate participation in non-surgical interventions such as nutritional counseling, low calories diet, exercise and behavioral therapy. They recommend me to obtain a nutritional evaluation within Kaiser health plan. I'm fairly new member of Kaiser. I had tried different forms of diets even went to Weight Watcher. My BMI is 50. I have a gallbladder disease (it has not been removed yet), borderline cholesterol, degenerative disc disease (had back surgery in 1999) and also major depression from weight problem. I was on and off diet since I was 12. I don't really have enough evidence to prove for my appeal. Help me.. what should I do?    — Princess V. (posted on June 29, 2002)

June 30, 2002
Dear Vonda...I am so sorry (and surprised!) you were denied by Kaiser. I have Kaiser POS too, and had no problem getting approved, although it took a while to jump thru all the hoops. Please email me at [email protected] and we will see if I can help....
   — rebeccamayhew

July 1, 2002
My insurance denied me also. I handled my 1st appeal and thought I sent enough info to prove a need, was denied again. Then, I contacted a lawyer who specializes in overturning denials. It took several months but they gat the approval. Maybe they can help you. [email protected] Good Luck!
   — Paula B.

July 2, 2002
To my knowledge, if you meet the minimum requirements (BMI>40, or >35 with co-morbs), you <i>cannot</i> legally be denied the surgery in Maryland or Virginia. I swear, I read this somewhere, but I cannot think of where! I'll look around some more, and if I find it, I'll e-mail you. Good luck!
   — webgrrlie

July 2, 2002
Just to clarify...you can be denied the surgery in any state if your employer has an exclusion, i.e. doesn't want to pay the premium for this type of coverage. Perhaps that is what happened in this case, although usually you can tell if the procedure is excluded when you make your initial inquiries to the ins. co...it seems stupid to have people go thru testing, drs. appts. etc., just to end up denying them in the end.
   — rebeccamayhew

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