Info needed on how to deal with ins exclusion

My ins. has written exclusion for wls. Is there any way around it?? Can anyone help me. My ins. provider is Aultcare.

Cynthia, Yes, there is something you can do. You can submit for surgery, and when you're denied you can appeal. An appeal can be done by you, by your surgeon, or by an attorney (in increasing order of success). If you BMI is below 40, and if you have no comorbidities (obesity-related illnesses), you chance is not great though. I highly encourage folks to be a huge pain in their insurance company's arse when it comes to not paying for WLS... Good luck, Dr. C The Deaconess Surgical Weight Loss Center Cincinnati, Ohio (513) 559-2545

I thought I read somewhere on here that if there was an exclusion in the policy that you could not make them pay for the surgery. It brought back hope to me after I thought that it was a hopeless cause for me. I found out that my insurance had a pre-existing condition clause that would prevent me from getting the surgery done till 1/1/05 and that is the date that the exclusion goes into effect. So I had given up, but this gives me new hope. I found out all about the pre-existing condition clause after I had my first appointment with Dr C. and they had sent in for approval. Since then I have gotten a denial letter. So does anyone have any ideas where to go from here? Shelia

soooo....even if your insurance has an exclusion you still have a chance (albeit it a small one) to win an appeal? I'm planning on self pay but what a wonderful thing it would be to get them to cover it. BMI under 40 but have co-morbidities. Won't get my hopes up but I'll do my part to be a pain in their butts, its not like we don't pay for the darn insurance!!

I hate to disagree with Dr Curry but almost all of the people I have heard or seen who now have a wriiten exclusion for WLS are not getting approved. Even Walter Lindstom (Obesity Lawyer) does not take the case. Some companies exclude surgery for obesity not morbid obesity and those you can appeal. Companies are now saying specifically they will not cover weight loss surgery. There is one option- The EMPLOYER chooses the type of coverage to have. DON"T LET THEM TELL YOU DIFFERENTLY. If you can persuade the employer to get it added back in. you will get you surgery.