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!!!!!

When I read my insurance policy, I thought WLS was excluded cuz it said something about not paying for treatment for weight loss, but apparently that didn't include WLS. I called my insurance company and asked them specifically. I called them a few times, actually, to make sure I was getting the right answer.

Hi Dawn - Most insurance co. are looking for medical necessity which your PCP should point out in his referral letter. The insurance will exclude primarily for weight reduction (cosmetic). Having a BMI 40 and over, 100 lbs overweight and any comobidities (High Blood pressure, Diabetes, Arthritis etc) make the surgury medically necessary. Hope it helps.

Dawn Don't freak out! You are not the only one that has had to wait. I have AHC and PPO. First it was denied..So I appealed...Then I had to have a psychiatric evaluation.(No I am not crazy) LOL...Insurance made me go through it..I am now waiting and it has been going on since Nov 2004..I have been on a rollarcoaster, which is unnecessary stress. But I must think positive. It is hard....I will let you know when something happens Take Care Michelle P.