Exclusions

If a insurance company excludes the surgery, can you appeal that? If so does anyone know the process? Where would I begin? Any help would be greatly appricated.
Thanks,
Joyce

Hi Joyce, Yes appeal appeal appeal! I'm in the process of doing that right now. My employer is actually the ones that exclude not my insurance. Please make sure you understand the terms in your to make sure their not excluding certain things. It has happened so many times where the ins. excludes something but it wasnt actually what they was thinking, if that makes sense.Anyway call the ins. co and get a copy of the policy review it well and go from there. Go to obesityaction.org and they sample appeal letters that are good. I also bought the book Weightloss surgery for dummies that has a few appeal letters in there too.Well I wish the best for . Let me know how it goes. Never give up. I'm not. Not yet...........

Generally when there is an exclusion, that means your employer opted to exclude WLS in order to save money on insurance premiums.  If that's the case, appealing won't do any good.  You have not been paying the premiums to cover WLS, so they won't cover it.  It's like, some companies offer both medical insurance and dental insurance.  If you only pay for the medical insurance and then need a root canal, well, they aren't going to pay for it because you didn't buy the dental insurance.  If your employer excluded WLS, that means you haven't been paying for that insurance.  So they will not cover under any cir****tances. 

Kelly

Do they exclude WLS in general or just your surgery choice? If they are excluding your surgery choice of say, VSG because they consider it experimental, yes you can appeal that and many have had it overturned. If they  exclude WLS period, like the previous poster said, there is nothing to be done.