Written Exclusion

My girlfriend is trying to get the lap band surgery but her insurance has a written exclusion she is so upset.I am trying to help her out does anybody know if there is away around this.She has sleep apnea and thyroid problems.

I have a written exclusion as well, and I am in the process of appealing. I would contact the office to see if they can help you too. I would look to appealing, and make sure they do exclude and get a copy of the policy.You can go to obesitylaw.com and they have info that can help you as well.

Thanks we will try that.Do you think she should start the supervised diet and the other stuff.She did the sleep study awhile ago.

You can go to this web site and see if her state has a law with regard to insurance coverage for weight loss surgery:  http://www.endocrinetoday.com/view.aspx?rid=24541

If there is a written exclusion, that usually means her employer elected to exclude WLS from the insurance policy.  Some employers do that to save money on premiums.  Appealing usually won't help.  She has purchased an insurance policy that does not include WLS.  She's not paying for that benefit, so they aren't going to cover it.

Kelly

My company has a WLS exclusion in their new insurance policy. 

My State (Maryland) and the State the policy is written in (Virginia) both have excellent WL laws.  However, I was informed by UHC via the HR director that the laws only state the insurance company has to OFFER weight loss surgery options.  The company can elect not to provide such coverage.

My only option is thus to ask my company for a waiver to the exclusion, meaning a rider would have to be attached to the policy.

I've decided this isn't a viable option for me.  Maryland is an "at will" State, meaning one's employment can be terminated "at will". 

I like my job, so I've opted for self-pay in Mexico.

I've read on here that some people change companies, tho.

Sorry not to have better news for you...

Sheri
P.S. Just a personal aside:  she may want to research the long term complication/failure rate for the lap band vs. the sleeve gastrectomy (VSG).  There's one heck of a lot of people on the VSG forum who've had to have revisions from lap bands to sleeves - meaning additional surgery, added cost, scarring, erosion, and other complications.  The initial cost of the VSG is a little bit more - but once it's done, it's DONE. No paying for fills and unfills, no dumping or nutritional issues, etc.  United HealthCare just approved the gastric sleeve as a "proven surgery" effective 1 October - it's no longer investigational as far as they're concerned. The rest of the insurance agencies will be following suit in no short order, I'm certain.