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.” If you feel this is not correct, you should contact the Human Resource Department at the employer that the insurance is thru. They will have to make the correction with your plan. If this exclusion is correct, you would need to work with your Human Resource Department to see if they will make an exception.

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 series of life-threatening conditions. 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 6 months or more of physician-supervised weight loss attempts illustrating that you have tried unsuccessfully to lose weight by other methods. They may also have a stipulation that you have been morbidly obese for a certain time frame such as 5 years.