Insurance Exclusions--Check this out!!!!

Someone posted this to the main messageboard a while ago and I just found it. Check out this site (copy and paste site) http://www.kullmanlaw.com/pubs/client_aug04.cfm and scroll down to the ERISA/BENEFITS MATTERS. My Insurance has a very simple statement: Surgery for obesity and morbid obesity excluded. It's just a simple sentence. This gives me great hope! Gary, what do you think about this? Any way you can give us any specifics of the case as in " ? vs. ? " that we might be able to use.

JJ, Go back and read this again. Your plan exclusion CLEARLY AND UNAMBIGUOUSLY excludes "Surgery for obesity and morbid obesity." Therefore, it is in compliance, and you are basically out of luck. In the case they are discussing on the website, the judge ruled that the wording was not Clear and Unambiguous, because it stated the exclusion was for "expenses for weight reduction." Additionally, "sugery" was a covered expense under the plan. The judge states how "expenses for weight reduction," could be construed to include paying for Weigh****chers. Insurance companies have gotten hip to the fact that exclusions for WLS will be challenged, so they have begun to re-write their exclusions to allow no room for interpretation or ambiguity. I have seen exclusions that go even farther than yours does, by stating something to the effect that WLS is excluded EVEN IF it will treat a co-morbidity such as Diabetes, or Heart Disease. Insanity reigns when the almight dollar is involved. Dust off your resume, and find a job that covers WLS. Good luck to you on your journey... Roberta