Is Exclusion the End?

OK...my BMI is 45, I have my PCP referral, I have my history, I have seen the surgeon for the initial consultation, my records are on the way to the surgeon's office, things seem to be moving ahead. I just read the "fine print" and my policy (Unicare PPO--AHC, Wisconsin network) and have found a written exclusion for "services primarily for weight reduction or treatment of obesity including morbid obesity, or any care which involves weight reduction as the main method of treatment". Also, when I read the rest of the "exclusions" it looks like they can get out of paying for just about anything, the list is REALLY long. My agent seems to think I will still be approved, but I am freaking out thinking that this will be over before it even starts. Please let me know if there is anyone out there that has been through this nerve racking expreience. HELP!!!!!

Dawn, Do they expressly exclude 'surgery for the treatment of morbid obesity'? The exclusion you sited may only apply to diet and exercise stuff (like Weigh****chers, Jenny Craig, and gym memberships). Services excluded may not include surgery when medically necessary. Hang in there and keep the faith, Illini

Dawn, When you obtained the referral for the surgeon from your PCP, had they already contacted your insurance company to verify that they would approve the surgery? That is the first thing I did, before I even obtained a referral to the surgeon. I figure why bother with everything if they're going to turn me down? I was turned down five years ago by HMO Illinois. I tried again, and this time, sent in a letter of my own, along with a letter from my doctor stating it was medically necessary. In a few days, I had an approval for surgery. I then was given a referral by my PCP to see the surgeon. With my particular insurance I was told they must approve the surgery before they'll even allow a referral to be written for the surgeon. Otherwise, if they deny you the surgery, you could wind up being liable for the surgeon visit. I know I can't afford that!! Good luck in your journey, and I hope it all works out for you. Dayna 310/308/120