Having trouble with insurance not covering any weight loss issues?

I was denied an umbilical hernia and stomach hernia procedure because they were brought on by obesity and the insurance company doesn't have coverage for any medical problem brought on by obesity? To me it's discrimination and I think I need a lawyer? Anyone?

have you had weight loss surgery? That is the only way I can think that hernia surgery would be denied. Obesity is not a legal reason to not cover anything medically necessary. 

If there is an exclusion on your policy against weight loss surgery,that is a different thing. 

Something is not right.  They cannot refuse to address a medical issue just because it was caused (or contributed to) by being overweight.  That would enable them to refuse to pay for emergency services if you had a heart attack! 

It sounds more like a potential miscommunication to me. Were you attempting to have something else done in addition to the hernia repair (such as a tummy tuck or skin removal)??

Who told you about the denial? Do you have actual correspondence from the insurance company? 

Something doesn't add up, but I don't think you need an attorney to resolve it (which, by the way, can take a VERY long time and cost you a huge amount of money).

Lora

edited for typos...

A lawyer is going to be expensive and time-consuming. Instead, I would suggest that you check that you understand things correctly, and that you can find how your specific case is going to be covered.

Get a copy of your insurance benefits book-- you can often find them online or get one from your HR person-- and look through carefully to make sure you understand correctly.

I'd also suggest calling the phone number listed on the back of your card as well. They can't promise you for sure if you're covered (or not) but they can clarify the language in your plan and answer questions.

Now that's a new one, and it sounds hinky at that.  To refuse to cover any obesity-related illness opens a Pandora's box for those with GERD, Type2 Diabetes, bad backs, knees, heart problems, etc. 

I would find out what their appeals process is and start there.  Maybe someone got confused about not covering "treatment of obesity"....totally different.  You may need an appeal, but not necessarily a lawyer.

I've had 3 appeals they denied me first for my tummy tuck portion that the skin didn't hang low enough.

2nd denial something about not falling under the criteria something about not seeking medical attention for a rash. And this final one that stated that my insurance company has an exclusion that ANYTHING falling under medical attention caused by obesity would be denied! UHUH I know if my umbilical  hernia ruptured and I went to the hospital? She said not a penny! I actually have her taped. And your right alot falls under obesity which is 35ibs over weight which is 5 million americans! By the way I'm healthier than most so called skinny people I know I still have some weight to lose but my cholesteral 175 no meds and my pressure 110/70 sugar level good . I need my Bariatric surgeon to do my hernias ( because of my lap band ) no one should be in my stomach without the knowledge one hernia is right above it! And so I'm not covered because it is due to obesity!!

Okay - so you're trying to get a tummy tuck with it too.  My insurance didn't cover them no matter what and that was with them covering my wls.  Have you tried for hernia repair without any plastic surgery?

That's what I'm going to do now however it's going to be done by my bariatric surgeon so the best I can hope for is out of network benefits and now I have to somehow prove they didn't happen due to my being over weight! I did have 3 pregnancies. And my brother had an umbilical hernia hes not obese! I'll let you know what happens. Thanks for your response.

Getting cosmetic surgery after massive weight loss is COMPLETELY different than them refusing to treat a medical condition that was a result of obesity (which is what you originally indicated)!

I know of NO insurance plan that wouldn't cover a hernia repair, but MOST insurance won't cover the cosmetic removal of excess skin and the skin tightening of a full tummy tuck.  Their problem is that you don't meet the criteria for "medical necessity" for excess skin removal.  It is common for insurance to require that the excess skin hand down over the pubic bone and that you ahve documented evidence of rashes and attempts to treat the rashes in non-surgical manners. so THAT is extremely common.

Can you share with us exactly what the insurance company letter actually says in that final denial?  I still think you are misunderstanding what they are saying.  I simply cannot believe that your insurance policy won't cover treatment for a heart attack, stroke, diabetes, hernia, etc. just because obesity contributed to them. I think what they are saying is that your extra skin is a non-medical issue that will not be treated. 

Lora