Exclusion Question

If I have an exclusion on my policy (Fully-insured), do I have a chance in getting approved if I can prove medical necessity?  I'm just wondering if I need to explore other options.

Kelly

If your policy is not self-funded, you don't have much of a chance, sorry to say. You can try, but don't spend 2 years on it fighting like I did! I should have bought the bullett and just paid for it long age. It has only been 3 years and almost paid for itself already!

Good luck!

Bonnie

Bonnied, Not trying to be too personal, but what did you do to get financing for your surgery?

I got a personal loan from citifinancial, they had the best rates. You can also explore capital one health care finance, patients at my office use them with a lot of success. Yeah, I know it's not easy, we are far from well off at my house. But the payment is $200 per month. So instead of buying a new car when it was time, I kept my old one. The trade off was worth it for me! I have spoken with many pateints who wouldn't dream of financing 20k for surgery, then go downstairs and jump in their 50k SUV to drive home, it makes no sense!

Good luck!

Bonnie

If it's a specific exclusion, medical necessity is meaningless--they don't care, they won't cover it. The only shot you really have is talking to your company's HR deprtment about getting rid of the exclusion when it's time for policy renweal, but this is a long shot since it would likely result in an increase in rates for everyone.

Just FYI.... Companies can have WLS in their plan and then change it mid year...

They do not have to wait until the plan year ends or begins...

I had coverage went through my surgeons program and everything was predetermined in 6/08 and on 9/2/08 the had the weight loss coverage excluded.

How do you get that to happen?  I have BCBS of FL, and when I went in for a Lapband consultation, the insurance guru there said that my company has an exclusion.  Fine, I thought, it isn't a huge company, perhaps I can ask that they change that.  I talked to HR, and they said they had no idea what I was talking about, and that the BCBS representative said it was never covered.  I emailed her the website data from BCBS of FL, where it says it is covered if medically necessary on a case-by-case data (information I got here on this site, thanks!).  She is looking into it for me, but if there is specific language or description of the exclusion, I would love to know what it's called.  That might help!  I've talked to several other people in my company (about 700 US employees), and several would be willing to sign a petition to change the coverage.  I told HR this as well, and asked what would be needed to get such a change in coverage made.