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Clear Lake Regional Medical Center
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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 obesity surgery or "treatment of obesity." 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 one to five years of physician-supervised dieting or a psychological evaluation, illustrating that you have tried unsuccessfully to lose weight by other methods.

What can I do to help the process?

Gather all the information (diet records, medical records, medical tests) your insurance company may require. This reduces the likelihood of a denial for failure to provide "necessary" information. Letters from your personal physician and consultants attesting to the "medical necessity" of treatment are particularly valuable. When several physicians report the same findings, it may confirm a medical necessity for surgery.