I have question about a insurance

There is a insurance I could get but the policy says covered- weight control programs- Prescribed under a physican's supervision when medically necessary for treatment of a specific ailment covered expenses are limited to doctors office visits,testing,and dietary supplements prescribed by a physican.It does not cover commerical diet programs,health club memberships,or any other similiar plans or facilities. NOT COVERED--- Gastric plication expenses related to gastric plication and gastroplasties (weight reduction procedures such as ataping the stomach. So my question is is there a chance to get them to pay?This is a ppo plan were you pay 20% and they pay 80% once you pay the deductable.

Sorry, WLS not covered. The exclusion is clearly and unambiguously written as required by insurance laws. Find another option. Good luck, Roberta

There is always a chance. Gary got my friends covered by BCBS of FLorida. It was a DS which was excluded. And they let her go out of network. Ask him. They dont like lawyers and always work settlements out. Good luck LR check out www.obesitylawyers.com

This is NOT the same situation as an exclusion. In your friend's situation, DS was not on BCBS's INTERNAL list of approved procedures. There was not an EXCLUSION disallowing the DS written in the plan/policy. Those issues can be gotten around in lots of situations. However, the plan wording EXCLUDES bariatric surgery. Of course, you should always try to appeal, but your chances of winning are slim. The exception to the rule would be if you had a life threatening comorbid condition like diabetes, that was not controlled by conservative treatment. In that case you could argue that WLS is the only, and most effective treatment remaining to control the diabetes. You could also do a cost analysis of treating all of the problems that would arise from diabetes from insulin, to kidney failure and dialysis. Lawyers will tell you that insurance companies don't like them, and that the insurance company will settle nuisance claims. Talk to anyone who has worked for an insurance company, and they will tell you a very different story. In the majority of cases I've seen personally over many years, the lawyers didn't have a clue what the policy/plan covered, and they became the nuisance, not the claimant, or the claim. Of course, their is the rare exception... Most people who are covered in the US are covered through their employer under an Employee Benefit Welfare Plan, governed by ERISA. The insurance companies know that RARELY will anyone sue them, because attorney's don't want to take those cases - there's no money in it for them. Bottom line. You have to know the rules of the game if you want to win.