Denial of RNY due to exclusion from insurance company

I just found out today after being denied for the RNY that there is an exclusion for any WLS on my insurance policy. Has anyone been successful in getting your surgery covered from your insurance co. when there is a WLS exclusion??

Any advice would be greatly appreciated.

If it specifically states no surgery, then you're SOL. You might need to explore going to Mexico; there are some very good surgeons with low costs, including accommodations and travel.

Most medical insurance states "weight loss programs" are not covered, which is Weigh****chers, etc., just because those programs fail, but surgery is not a weight -loss program.

Keep looking.

My ins excluded WLS. I went to Mexico. As stated above there are some very reasonably priced deals there. I have no complaints at all about my experience , in fact I feel I got better care than I would have locally. If you need this surgery invest in yourself. It will cost you less than price of a decent used car in Mexico.

Sorry you experienced that disappointment. But it's always a good thing to check your policy to make sure a procedure is covered.

When I had my RNY - my insurance covered it. Since that time, my company has switched carriers and it is specifically excluded. I work in health insurance, and believe me - I get it. I get that, in order to keep costs down for both the employer and the employee, certain coverage may be excluded. But, I dunno; excluding WLS seems like; no FEELS like discrimination to me. I'm sensitive on the subject obviously.

I hope you can find an alternate solution.

Sandie

I agree - either obestty is a health risk or it isn't. Tell the medical profession to stop beating us up over how we're at such health risk, or treat the issue using the only data-based method that works - surgery. Having an exclusion for WLS, is like having an exclusion for cancer and telling a cancer patient to hope for spontaneous remission.

At this point, shop around.

Generally, if there's a flat-out exclusion, it's very difficult-- if not impossible-- to get an exception.

Your options would then be to self-pay (either in the states or in Mexico), or to look into other insurance plans.

If your plan excludes WLS, it's because your employer decided not to pay the necessary premium for WLS coverage---and there's no way you can get your insurance carrier to cover it.

I suggest you start looking into self-pay options. You can most likely get the surgery of your choice much cheaper in Mexico, but PLEASE---research your surgeons very carefully, and make your choice based on skill, not price.