another ins question folks lol...

DH and I are about to switch ins companies. We will be going to farm bureau and getting blue cross blue shield thru them, i believe its Tennessee Rural Health care thru blue cross blue shield. It says that they dont cover sugery to reduce wieght, but would this exclude people who are deemed medicaly neccesary to have the surgery? I have chondromalacia in both knees that will most likely require surgery, arthritis in hips, knees, feet. I desperately need this surgery or i fear i will never see my children have children of their own, never see my daughter walk down the isle, never have a full life. I have a bmi of 53, am roughly 360 lbs and 5 ft 9 in tall and 31 years old. I so want and need this, can anyone offer any insight on this insurance question?

I was told, on another WLS group I am a member of, by a man who claimed to be an attorney (you never know for sure on the internet) and it made sense. He said that if there is an exclusion in your insurance policy against weight loss surgery then you cannot get approved no matter what for them to pay for it. He said the reasoning was that they could not be legally forced to pay for what was never covered in the first place. However, if you can prove that others with the same policy (remember there are 100's of BC/BS policies some with WLS exclusions & some without WLS exclusions) have been approved then you have a case. Something to think about when choosing an insurance is to ask first about any exclusions. Greg

Exclusions are hard to get around but you can try. Most of the time they don't care what co-morbidities you have. Don't give up, still try.

Tina, I went through this with another company and they were firm on their exclusion policy. If it is a "stated exclusion" the only thing you can do is apply for it and if/when denied follow the appellate process and hope for the best. The problem I ran into was that even during appeals that the final decision to be made had to be based on current policy and that was the problem for me as no matter what a medical professional indicated, they used the fact that the exclusion was in my policy and therefore I was denied. I ended up having to change jobs and insurance to have it done. Sorry not to have more positive news but this is from my own experience. I'd say put forth the effort and try at least ... Best of luck!