Is Exclusion the End?

OK...my BMI is 45, I have my PCP referral, I have my history, I have seen the surgeon for the initial consultation, my records are on the way to the surgeon's office, things seem to be moving ahead. I just read the "fine print" and my policy (Unicare PPO--AHC, Wisconsin network) and have found a written exclusion for "services primarily for weight reduction or treatment of obesity including morbid obesity, or any care which involves weight reduction as the main method of treatment". Also, when I read the rest of the "exclusions" it looks like they can get out of paying for just about anything, the list is REALLY long. My agent seems to think I will still be approved, but I am freaking out thinking that this will be over before it even starts. Please let me know if there is anyone out there that has been through this nerve racking expreience. HELP!!!!!

no you need to talk to Gary Viscoe and see what he suggest that you do he will guide you in the right direction. Ruthann J.

I think the key here is the word "primarily." Do you have comorbidities? That's how I would approach this - appeal based on the fact that the surgery will treat your co-morbid conditions.

I have High Cholesterol, stress incontinence, joint pain (back, legs, hips and feet), heatburn, shortness of breath, headaches, snoring, fatigue...all of those "minor" problems. No diabetes.... I haven't been denied yet, actually, the surgeon's office is still waiting for the records from my former PCP...I'm just trying to get a jump on it. I have a letter from my new PCP (*****commended the surgery), the surgeon, and my former PCP (who treated me for two years and knows more about this struggle). I'm just very anxious about the whole thing. I am at my highest weight ever, and am feeling that this is surely the last resort.

Is it heartburn or is it gastric reflux? My GERD began to put acid in my lungs and I have had terrible respiratory problems for 3 years without realizing that they could be caused by or made worse by GERD. I thought I just had heart burn until my doctor diagnosed Gerd a number of years ago.......... and I still didn't want to believe it for awhile. Eventually, I realized that all my "heartburn" were the symptoms he had given me for Reflux. I kept blaming my respiratory problems on allergies asthma etc and could not understand why sometimes my allergy medicine just couldn't seem to touch the problems........ well, DUH, the burned feeling inside my lungs was due to acid. I was treating GERD until the ins. co. wouldn't fill my prilosec, and kept the prescription instead of mailing it back. They told me I could use OTC medicine and didn't need it!!! It was after they did that, that I ended up with such bad lung problems......... makes me want to go slap someone and tell them not to do that to someone else. So maybe your problems are not as minor as you think, I would have called mine minor until I got where I was coughing all the time and everything irritated my lungs and started me coughing. The good news is that meds. that the pulmonologist put me on to improve my lungs before surgery are working so well that I don't mind that they cost a zillion dollars....LOL So maybe you do have the comorbidities and weren't even aware of it.