HOT!! Don't be SO SURE you are excluded: Here's what the state says:

Yesterday I talked to the Plan administrator of my husbands insurance co. I aksed how my case was going in the review process for med necc. Well he told me it would be a week before we knew anything, but it really didn't make a difference because it would be denied due to the exclusion of treatment of exogeneous and morbid obesity. He went on to tell me how dangerous the surgery is, it could cost the school district 1/4 million dollars if something goes wrong. Wrong I said, if something goes wrong without this surgery it's going to cost them a lot more. Well I was angry, and thought something is wrong here. Medicare, Il public aid, pays for this and there are illinois state statues supporting that fact. So I've spent 48 hours on the keyboard, now sit down:::::: According to the Comprehensive Health Insurance Plan Act (215 ILCS 105/8) from Ch.73, par. 1308) right after Sec. 8; Minimum benefits 1-19. Well the ever so popular exclusions are listed. Read number 1. It's interesting, but number 21 is the winner!!!! Allow me: #21: Excluded: Any expense or charge for weight loss programs, exercise equipment, or treatment of obesity, EXCEPT WHEN CERTIFIED BY A PHYSICIAN AS MORBID OBESITY (at least 2 times normal body weight). Read all the exclusion clauses. I wish I could attach a link, but I had trouble. If you type in 215 ILCS 105 you should be able to find it. It would be under Illinois Lesilative Compiled Statutes. The way I see this is the school district cannot write an exclusions like this when an illinois statute supports treatment for morbid obesity. Also know in the works are plans by Senator Mattie Hunter she is working very hard to get illinois to wake up and notice the epidemic of obesity. Write to her. Today I also was disheartened by the fact that todays generation will inevitably die sooner than any of the previous generations due to obesity. I have a type one diabetic son, he's obese and I worry so bad about him. You just don't know what diabetes does to you and your loved ones. I hate this disease. Well I hope this is some help. I am running this by the Insurance guy tomorrow. Read the whole statute its about 23 pages long. It's worth your time, and it may be your answer. I sure hope it helps me. I'm sure they'll come up with some other wall. God bless all of you on your journey. Barb

Barb, I think, unfortunately, that insurance companies do have some iron clad way around paying for surgery if there's a written exclusion, even for MO, even if it's coded correctly, etc. There are a ton of people here who just arent able to get around their insurances goofy exclusions. However, there are also many people here that hired Walter Lindstrom and had their denials appealed and overturned. Sometimes its just letting the ins. co know that youre not just going to 'go away'. That said, I know there are certain ins. that just will not pay for WLS. Good luck..keep us posted! Kathy

Because I too am in the middle of doing some fighting/conforming to my insurance rules I was anxious to read what you were talking about. I am understanding that the above mentioned Comprehensive Health Insurance Plan is only for people who do not have private insurance. It is not rules governing private insurance at all. Please correct me if I am reading this wrong, I would love to be wrong in this case!!