WLS EXCLUSION

HAS ANYONE EVER WON A EXCLUSION?? I HAVE 2 DOCTORS THAT WROTE LETTERS SAYING IT WAS MEDICALLY NEEDED I LIVE IN OHIO

Last year (2003) there was an exclusion in my policy that said they will not pay for weight loss of any kind. After the 1st letter, 2nd appeal, 3rd appeal, and last appeal, I was denied. My wife wrote the President of my employer a letter and we got a call from the director of HR. She worked for us and got the exclusion changed for 2004 to read, "Related to weight loss or treatment of obesity; except for surgical treatment of morbid obesity." Last year, we spent 4-6 months fighting appeal after appeal. When there is an exclusion in your policy the insurance companies will not budge. You best bet is to talk to your employer to get the policy changed. This time around, it was easy, I did not have to fight at all. I was approved after the first letter. The things I had are; a letter from my PCP, my medical records (10 years), my Psych Eval, my Nutrition Eval, a letter from my mother, a letter from my dad's Cardiologist with a diagram of his heart and his 4x Bypass, diet History and a letter from me. Bottom line, it is imposible to overturn and exclusion without legal help. I spent 6 months fighting Anthem. The easier route would be to talk to your employer to see if they could get it lifted. Good Luck!

Heather, I have been appealing for 2 years now and my insurance company won't budge. I am in the process of writing the President of the US and hope that he may be able to help us. Hang in there! Karen Schoonover