Exclusion help for massachusetts

Hi I just posted this but I dont' see it on the site so I thought I would try again. I am in serious need of help.. my insurance excludes WLS of any kind. I have heard that in massachusetts legally they can't deny the surgery. Does anyone know how to fight this? Any sucess in fighting this? I heard that throught the state board of insurance this can be done. Any help would be greatly appreciated! Any websites, phone numbers or any info. Thank you Gina

Well, I can't say I have any help to offer, but I am in a similar position. I would also love to hear any feedback. I have a policy (out of NH) that excludes all WLS surgery and it cannot be appealed. Before realizing the extent of the exclusion, I started attending the Lowell General program , met with my PCP and had the intake with the Nurse Practitioner set up. I spoke with the Insurance Coor at the hospital who also contacted my insurance and she said it was hopeless. When I discussed self- pay, she said that they do not like to do that because of the tremendous expense and outside possibility of complications, tests etc... that just add up $$$$. Her suggestion was to buy a 1 year policy just for myself that would cover the surgery. The policies are expensive, but not as expensive as paying for the whole WLS. I have not had any luck finding one yet. I am bummed that I have perfectly good insurance and am "held hostage" by their decision. I need to do some research and see what happens if you have a Primary and Secondary Insurance policy. Has anyone out there come across this type of situation? I am ready to make a change and will do whatever it takes!! Thanks- Carolyn

Hi Gina Your insurance company can not exclude anything that your doctor and the state board believe to be medically necessary. If you have a high BMI or serious co-morbidities you will have a good chance. One problem is it must be a Massachusetts Insurance policy. If you work out of state or you work for a company that writes their health insurances out of an office in another state you will be out of luck.