bariatric exclusion (cross posted)

Does anyone know anyone that was approved for revision surgery (rny to a ds) the insurance deemed the procedure medically necessary but there was a bariatric exclusion in contract?
Thanx for the info......Yes I am still fighting this

Not when there is an exclusion, in that case you are pretty much screwed. I don't recall reading of anyone who has succeded with the exclusion. Trust me I wish I did cause I'd fight for revision myself but everyone I've spoken to or read about had no success.

Your screwed. If bariatrics is not covered.............it's NOT covered! :-( A lot of insurance policies don't cover bariatrics. I have heard that WalMart doesn't offer insurance that covers bariatrics. That's a lot of employees just at that one company with no WLS coverage.

This is an issue with your particular policy, and if it's an employer provided policy, the exclusion exists because your employer chose to exclude bariatric coverage, and no there is zero way around unless your employer offers a different policy during open enrollment.

Sorry, unless you get new insurance or self-pay everything remains the same.  The answer is no and it will not change.  No means no!  And unfortunately there is no one to fight.  Like who could you fight?  If my insurance does not cover dental - and I say that I want them to cover the $20,000 in dental work I had would they be liable to pay my bill?  Hell no!  Because there policy states that they do not cover dental.  No, I can't make them buy a rider to their contract because I want it because they said - not included.

Well maybe, just maybe your employer will opt in for a WLS rider for just you.  Anything is possible.  Would they be wiling to pay more for you?

Unfortunately, if there is an bariatric exclusion there isn't anything you can do. Basically, the company who supplies your insurance has had bariatric coverage removed from the plan, likely due to cost. If it isn't covered there is no way to have it paid for by insurance and no way you will win even upon appeal. Sorry Randy.