Per the excerpts below, Healthcare Advocates, Inc was successful in obtaining coverage for a gastric bypass that was listed as an exclusion in the patient’s insurance policy.
[Insurance Information Redacted ]
We have received your March 15, 2006 correspondence. Healthcare Advocates, Inc is requesting benefits for gastric bypass surgery for [patient] which was previously denied.
... Mr. XXX is insured under an individual major medical policy XXX. This plan is not self funded. Mr. XXXX’s coverage under the policy became effective XXXX.
Mr. XXXX’s policy states the following under the Exclusions section:
We will not pay benefits for any of the following ...
including but not limited to ... obesity.
Based upon this exclusion, we determined that Mr. XXX’s services were not eligible for benefits. Subsequent to this determination… Our Health Management Services department determined that the gastric restrictive procedure is medically necessary and that Mr. XXXX meets the criteria...