What does this exclusion mean
This is the exclusion in the insurance policy where I work. Just wondering what it means exactly. SERVICES PRIMARILY FOR WEIGHT REDUCTION OR TREATMENT OF OBESITY OR MORBID OBESITY. Would my comorbidities factor in here. They are high blood pressure, depression, painful knees, and plantar fascitits of the left heel. I guess when I read it I see they wont pay for it if it is only to lose weight. But what if it is to lose weight to reduce your blood pressure and the otehers as mentioned above. I do not want to get the policy if they will not cover WLS. Thanks for any help. Donna
If you can avoid this policy then you probably should. While two factors could play a role in this, you'd be better off finding a plan that does cover it.
For example if the plan is out of a State that mandates coverage, like Maryland, and its not self funded, you could probably overturn a denial. But these are IF factors.
As for the co-morb argument as the reason for surgery, it makes total sense, but it is not acceptable at this time. So you can make the argument but they don't have to listen. The CPT code for the surgery would simply be surgical treament of obesity and that's where they'd snag you.
Gary Viscio
www.ObesityLawyers.Com
RNY 7/1/03 -166lbs
www.ObesityLawyers.Com
RNY 7/1/03 -166lbs