Exclusions....

Working for a large insurance company, I certainly understand the frustrations of getting approved. Many of us have a long journey with many bumps in the road. However, people with plans excluding surgery don't have much a chance at all. It just plain isn't covered, no matter what. I really get upset when I see this happen (and trust me it happens more often than not). More and more policies are excluding surgical treatment of morbid obesity. If your insurance covers surgery, consider yourself lucky (I'm sure you already do). On almost all of our policies that are renewing next year will have the exclusion. Also, make sure that your policy doesn't change when you are in the process of meeting your qualifications. I hope all of those who have these exclusions appeal until they can't appeal any more. I think it is a shame. I just want everyone to be able to have the same chance at getting the surgery as myself. Also... has anyone appealed an exclusion and won? I would love to hear about it.

We have never had anyone beat an exclusion. Not to say it could never happen, but it's unlikely. Dr. C

Wow ... maybe I was the exception to the rule. Granted, I had surgery almost 3-1/2 years ago and I'm sure policies have changed drastically. I was originally denied by BCBS PPO of IL, not because THEY wouldn't cover it, but because my employer had the exclusion. My surgeon appealed that surgery was a medical necessity and within a few weeks I was approved). I honestly believe that my surgeon's appeal made all the difference in the world. I most likely would probably still be jumping through hoops had he not pushed. With all the studies of the cost of care for the morbidly obese, I guess I don't understand the hesitation to cover surgery. Karyn

Karyn, I'm glad you got approved, but what you're talking about is not an exclusion. An exclusion means that your employer gets a cheaper rate by excluding treatments for certain things. Dr. C

Perhaps I misunderstood the BCBS rep, but I do recall them saying my company had a written exclusion ... believe me, I was ready to do battle (or try to make a deal) with my company! Like I said, it was a while ago, and I wasn't going to dig deeper when I did get the approval upon appeal, so I really don't know who (company/insurance/whatever) approved what. Insurance does make me nuts though! (I think insurance and pharmaceutical companies should be non-profit organizations, but that's another topic for another day!) Karyn

I was thrilled to learn there was coverage in my plan. I am very grateful! A co-worker had lap RNY and all but $2k was paid for by our insurance. It makes no sense to me that a surgery that could help prevent future health problems is still viewed as it is. I guess employers (or maybe some insurers?) still see obesity as a sort of choice. It seems the attitude is that 'well, if the person would just try harder, etc.'. Pfft. As if trying Weigh****chers (among other things) a good half dozen times isn't trying enough?