Overturning Complete Exclusion...

Good day, everyone. I've been reading through some of the posts on this board, and I see that several people are going through exactly what I am, at this point. My insurance (Anthem BCBS PPO) policy has a complete and total WLS exclusion in it (thanks to my husband's company). I have several comorbidities, and my BMI is 48. I'm 29 years old, have two small children, separated from my husband... and really don't feel like giving up and slowly watching myself die. But yet... it's hard to find strentgh when you receive such a low-blow... such devastating news. I don't know what to do from here. I called BCBS and asked her if it was a complete exclusion, regardless of medical necessity, and she affirmed, stating that it is something that the employer has placed into the plan. I called the local HR department (this is a very large national corporation), and she seemed clueless. I asked her if there was a way to lift the exclusion from my policy, and she referred me to call BCBS. I "kindly" reminded her that they were the ones that have placed the exclusion into the policy, not BCBS. She agreed (duh), then gave me a benefits hotline number out of state to call. (I've yet to call it, though. I've dealt with the people at this number, on other non-WLS issues, and I was transfered back and forth, disconnected several times, and basically never got any kind of resolution to a simple issue.) I have no option to self-pay or finance this... and I have no way of changing insurances. The insurance is through my husband's employer. I've not worked in over a year, as I haven't been able to find anything yet. (Gotta love this job market, eh?) I don't know what else to do. I have no idea if my husband's insurance will be changing again at the start of the new year... but even if it does, I have to wonder if his company will again insert this exclusion into the new policy/policies. I sent an e-mail to Mr. Viscio in regards to my situation, and am waiting to hear back from him. I'm hoping I can get the funds to employ him, if he feels there is a chance at overturning this exclusion. If anyone has any ideas, please let me know. I know several of us are going through this very same issue right now. I've created a Yahoo Group, if any of you want to join, to have a place where we can all talk about this, and brainstorm, share ideas, successes, setbacks, information, etc. If you would like to join it, go to the link below and sign up. (I won't be doing any type of annoying advertising or b.s. of that sort on the list... this will purely be an email list for us to discuss this topic, and try to help each other in any way possible.) Brightest Blessings, Bela To join the group, click here: http://health.groups.yahoo.com/group/wls_insurance_exclusion/

Hi Bela! I think you've already done the best thing you can and that is to contact Mr. Visco. Wait to hear from him and see what he says. Let's all keep eachother posted (no punn intended ) about our progress!! jeri

Hello, I tried to join your group but i use my jobs computer and they are doing some work where we cant access yahoo mail for the next 45 days, so im actually writing to see if you could contact me if you have any good updates. Im basically in the same situation except i do work but have bad credit and can't get financed. My insurance Humana has a written exclusion. I wrote to my HR dept who forwarded it to Benefits a month ago and i've heard nothing since. I really praying for all of us and hoope it all works.

Melanie, Call your benefits department and harrass them!!! Liz

Hi Bela: I am also waiting for a call back from my husband's HR department (I called them 4 day ago) I have been denied by CIGNA twice and each time they deny me they keep referring to ARISTA and that if my husband's plan has it I'm entitled to sue. I looked this up on the Internet and the best I can figure is that it is a governing agency that keeps HR departments up to date on laws on benefits of employees. I may be wrong on this but I'm going to ask to see if my husband's plan has it and if they will provide the money for a lawyer. If they do I will be calling Mr. Viscio my self. I'm tired of playing this "paper chase" game with CIGNA and wasting time. Mr. Viscio makes mention on his web site about ARISTA so you might ask him about also. Have you thought about dropping your husband's insurance and going with Medicare? I know several women in the state of DE who have had this surgery and Medicare has paid. They even paid to remove the excess skin. These women were married and divorced also, so you might went to check this out!!!! Good luck and let me know how you are doing with your fight!!! Rosemary

I think the term is ERISA for those who wish to google it.......