HELP!! How do I get around Group Health Exclusion?

I am a Washington State employee with Group "Death" PEBB. I am hoping to find a way around their exclusion of surgery "directly related to obesity" I am confined to a wheelchair and can no longer go with my weight the way it is. I'm afraid I will continue to gain and no longer be able to get in an out of my chair, up my ramp at home etc. Does anyone in Washington have any suggestions of a self pay insurance I can buy that would pay? Group Health said they won't pay for any reason starting in 2005 so I only have 1 year to convince them. I also need a primary doctor in Spokane that will support my request for the surgery and fight for me, rather than fight for Group Health. Any other suggestions would be helpful. Thanks so much Janice

Janice, Unfortunately, you have a direct policy exclusion from Group Health. And, since it is a state offered program, you may not be able to seek help from the WA state insurance commission. That's where I would start first. Call your local office to find out what steps you can take to try and get your insurance to approve your surgery. Secondly, do you have any stomach dysfunction? I have gotten approval for patients in the past who have gastroparesis. Check with your primary doctor to see if you have any indication for this type of illness. Finally, contact a lawyer who works specifically with obesity cases. I have some leads if you want to email me. Hope this helps! Heather Miller Program Coordinator Surgical Bariatrics Northwest