VERY IMPORTANAT ?? ANYONE ... EXCLUSION!!!

Can someone please tell me what this means!! Do you think their is any way that i can get around this? This is the exclusion in my policy ok, and i quote: "ANT TREATMENT OR SURGERY FOR OBESITY, WEIGHT REDUCTION OR WEIGHT CONTROL OR COMPLICATION THEREFROM OR RECERSAL OT RECONSTRUCTIVE PROCEDURES RESULTING FROM SUCH TREATMENTS" Now is'nt obesity the key word. It said nothing about MORBID Obesity. I am thinking their may be a way to get around it!! Such a small line in the exclusion to keep me away from being happy and healthy. Someone help me!!

Felicia, hey girl! I see you finally got them to send you the stuff! Lets see about that! Did you notify the ins commissioner and see what they said? With what you typed I dont know if there d be a loop but if so its due to the obesity part! Youd think in the end if you were saving them money they d be happy! This is what I d try if I were you! First of all, have you had any pre testing done like sleep studys, cardiology work up etc? Reason, asking is the thin line can be with those things being able to be preventable/cured with weight loss! After all thats also discrimination against you just for you being over weight! You may have to get an atty to battle with you! Let me know if I can help! I am still praying for you! Kerri

As i type i am pulling up the ins com. website. What should i say??

I wish you luck. I am not understanding the way it's wrote. Reading it has me confused. I would certainly call. But this just sounds like the exclusion that most of BCBS has. You can only have it with morbidely obese issues. They write this stuff to the term. They say enough to confuse you(obese) but not enough to get them sued (morbidly obese) I read this and think it's a medically necessary procedure. Hence them leaving out Morbidly. Get all the amo you can. Check out my profile it gives you a list of what you should have. I recomment you haveing all that and them some before you even consider submitting to the insurance. No reason to be disappointed if you don't have to. Don't leave them room to turn you down. NAT BAF Board http://www.obesityhelp.com/morbidobesity/member-interests/black_american/

thank you!!

Hi Natalie my name is Lisa - I have just had a big problem with UHC and sounds like you know about it. I called customer service for my son several times in Febraury - YES the surgery is covered. Called them again with surgery code - YES covered. When the predetermination letter went in - there is an exclusion. Employer never gave son a handbook in January when they started with UHC - but they sent him one on 4/20 - 90 days after I applied. Furthermore - the handbook has a little date on the back of 3/19 - which I think means it was put together after I applied for his wls. Sounded pretty strange to me. Still customer service, Human Resources keep insisting YES there is coverage just send in all your paperwork. Their payroll is done off site and administered by a larger payroll company. I told them to send me a fax stating this was covered but they kept putting me off. Finally today I called HR manager and told her I noticed the little date on the back and I believe they put in the exclusion after I applied - I told her not to bother faxing me anything, I was getting an attorney. That seems to have made her very nervous for some reason, because within five minutes her boss called me making a lot of excuses and telling me he would get back with me. What do you think? Lisa Solis

Natalie - I have another question for you. I was thinking about going with BCBS PPO of Georgia privately for my son. When I tell them he weighs about 340 I wonder if they will cover him. Also - how do I ask them if they cover WLS without being so conspicious? How long do you have to have insurance with them before you can apply for WLS? Any help you can give would be greatly appreciated! Lisa Solis

Hey Lisa okay first let me tell you something alot of people don't do and can be sooo simple. First record your call, get a college recorder and hold it to the recever. Let them know your having a problem hearing for them to speak up LOL it works. Experiment with a neighbor. You'll find that it record rather nicely. When recording make sure you speak specifically. Don't threaten with a attorney before getting it on your recorder. I hope your account is not already marked cuz if it is they will be very cautious to talk to you and you won't get any evidense. Ask for there name and extention or cst # anitial of last name if they don't want to provide it all. Ask them for a fax # just for them. Be nice but the fax #will also help to identify them. Make sure they have YOUR!!! policy number and your member ID... Them ask them very specifically for MY policy is this covered. If they say YES!! you got them. If you can get them to repeat it in detail that would be great. Ask them what section of YOUR handbook you can locate it if possible but don't insist if they have to dig it up. Don't want them digging to deep on this call. When the call is almost over ask them for there supervisor name and call back if necessary. You may not get the call back # but just ask anyways and be sure to get a name. If at all possible have a whitness on the 3 way with you. Or better at your home when you dial. Be sure to record when they answer beginning of call. Now I know this may sound strange and extreme but what I found out is that if you have proof that they said they would cover it at anytime. They would have to cover it. Sounds extreme I know, but if it went to court, with an attorney you would come out victorious. I learned that the heard way. By the time I tried it with UHC I was to late I was marked already. But I did it with BCBS when I changed over and I had a friend I knew to dictate it for me and I had it notirized. I was not taking a chance. Have that person you get on the phone fax you paperwork saying it's covered. Be overly nice and nonchalante. ex: "Oh yeah I had that in my book hmmm can you just refax that I can wait I am by the maching." Now I am scared becuz before they talk to you they usually read all the notes. I am scared they have you labelled. Boy I am a bit nervous. But you have to try. Also A policy can not change until the next renewal. Did they have a renewal since you initially requested. Did they give you a 30 warning of the change. It's illigally changed if they did send out documentation. Do look for something coming in the mail. They may try to cover there buts now. If the date on the of the booklet is recent and you have to end up going to a lawyer. Then the booklet is good evidence. Also tricky, they may try and say that the booklet was there warning to you that the policy had changed. This can be tricky so watch what you do right now. Don't go off the radar with them to quikly. Okay if you change insurance bcbs is a wonderful insurance to go with. Now rumor has it there not covering for next year unless purchases for rather alot of money. Alot of companies will not sign on to this. But when you decide on what policy you want to buy before you sign the dotted line ask them for a copy of exculions. this will highlight what is not covered. And as I stated before becareful with the obese and morbidily obese words. I know this is alot to take in it can be overwhelming but you would be surprised how you are able to take control of the situation with determination. I am gonna email you my person email and IM... This is way to long of a message sorry, I can go on and on and on..... Also there is no waiting period once it goes into affect you can call the doc that same day!!! NAT

Natalie - thank you, thank you for all the info. UHC told me repetedly that the surgery was covered - but would not fax anything at all. I was so upset at the end - I threatened the benefits administrator on his job with an attorney. For two months UHC stated that the surgery was covered. They threw in an exclusion after I made the claim - and the date on the handbook is proof. I had two 3 way calls with folks at UHC - always with customer service saying the surgery is covered but claims saying other. I have documented phone calls to a lady (Claire) at Human resources stating she checked and it was covered, and another lady (Lori) at benefits saying it was covered. Today they changed the story at Customer service. I sent in a complaint to the insurance commissioner of Georgia and called a local attorney. They seem to have "corrected" their internal problem today. When I called UHC yesterday, it tooke them about 15 minutes to review all the notes before speaking to me. They must have told me the surgery was covered at least 25 times in the past two months.

try going to the atturnty .they will call you back and email you . they will let you know what they can and will be able to do for you . l called and was toled about them but Paul and l just thought if l wighted until l could ching my ins. maybe l can have it done but if l have any truble then l will get back intuch with him for his help. very nice and helpful. sarah