Can you fight insurance when there's an WLS Exclusion?

Hello to everyone! I am brand new here, even though I have been peeking in from time to time. I am glad to have found a place where there are others like me, who are seeking WLS or dealing with it post-op. After years of wanting to have the Lapband done, I finally went to a clinic to do more research. After meeting the DRs and staff, and getting all my questions answered, I have decided to go for it. (At BMI of 44, I think it is about time I did Something!) Here is where I got stuck. I asked the insurance billing lady while I was there if MY insurance would cover it. (Being we got a bit of a run around when we called our insurance provider direct). Finally I got an answer, but unfortunately, the answer was "no, they don't cover WLS". At the same time, she told me I could hire a lawyer and fight it. So, I checked into that and at the same time, had DH call the insurance people. (They seem to give a straight answer to a MAN on the phone!) Anyway, we found out that they have WLS as a "written exclusion/exemption". I got back in touch with my weight loss clinic, and I was told that if the policy has it written like that, then it is almost impossible to get the insurance to change it's mind. Almost at the same moment, I got an email back from a lawyer with a list of fees etc, to fight the insurance. So I am feeling like I am right back at square One! What I would like to know, if someone else has gone thru this, is: Is there ANY point in hiring and paying for a lawyer when it would be futile to fight the Written Exclusion? I don't have a trust fund anywhere that I know of, and if I have to pay for the surgery out of pocket, I will need to save every penny. I can't really afford to pay $1000 to a lawyer and find that I still have to save up the $17,200 afterall! I am sorry this is so long, but I am so completely frustrated. I hope someone out here has walked the same road I am now on, and can pass on some advice. If there is a chance to win the fight against the insurance company, then I will gladly pay the $1000 right now. I just don't know if the lawyers are just saying whatever they need to, just to get another check. So, someone please help! A newbie in Everett, WA. Sharon

Good luck fighting the exclusion. If you have any luck, be sure to post it here. My insurance has the same exclusion. I don't have the money to fight. The insurance knows it. They have us over a barrel. I'm also trying to find money for self pay. Hope its before I die. I am very discouraged. To the point of not caring anymore. about anything.

Hi, Even 9 days post-op, we (husband and I) are starting to get crazy, mixed-up bills from the hospital. Some of my tests were covered; some not. Some of my visits with my PCP were covered and some not huh? Premera has an exclusion on wls but they seem to be paying my hernia-repair-related appointments. I have this feeling we are in for legal assistance, which my husband and I cannot afford. So this problem is not only before--it's after, too! Thanks. Lauren

I'm in the same boat. Lost a lot of weight (over 200lbs), and I'm looking into getting this covered. My quote was $15,150 (Abdominoplasty extended & Dermal Mastophexy), that was with the Surgery center and anesthesia. Hope we can all find the right resources, I know I'll be looking. Good luck!

Hi Sharon, you need to post this on the national board, not just the washington board, i think there are alot of people that have fought and won. Good Luck...Paige

You can find Lawyers that don't make you pay anything unless you win and this might be something to look at. Just keep in mind that it may not help. I know of some surgeons that can finance your surgery and if this an option then maybe you could try that, Call Dr Thirlby's office in Seattle they don't make you pay up front costs and then they will work with you if you insurance doesn't want to pay, at least you could have the surgery and worry about the cost later??? Take Care

H i sharon, you can fight your insurance first without a lawyer too. and keep this in mind never quit. fight fight fight. its possible you can overturn an exclusion though its very hard, some give in some dont. i will be praying for you marla