My policy has a specific exclusion for WLS but...

I am not going to give up. I saw there is a lawyer on this board with a practice to help fight insurance companies for WLS. Or, I was thinking of getting my gall bladder out or my abdominal hernia repaired with WLS on the side. Anyone done that? My last option (before getting a 2nd mortgage) would be to get a new job with insurance that covers it. Any one have advice for me? TIA

I vote for the new job. I wouldn't want to work for a company that didn't support my health and welfare. Just my humble opinion. Roberta

Roberta, thanks for answering. I read your profile and see that you are an expert! And I take it that you are saying no, I have no real hope of my insurance helping? Thanks, Libby

Libby, Louisiana is tough as they have no external appeal process. In other words the normal HMO plans are the same as self funded plans as there is no entity that would overturn it. That said, you may want to appeal anyway just to see what happens, and I am not saying use me or anyone else, but you should give it a shot. I have overturned exclusions and self funded exclusions, one just last week which was an iron clad exclusion that they finally overturned. Now, this is not a rule, it is an exception, BUT in some cases these plans have an option for an external appeal that you don't always know about. In one case in fact the plan said nothing about having that process but suddenly when demanded they said oh yes we have an external review process. My advise would be give it a shot. File an appeal on your own and put in the appeal that you demand a copy of your appeal rights and the full process you will expect. See if there are any loopholes. At worst, you are still denied, and can explore other options. Good luck. Gary