BC/BS Onpoint exclusion??
BC/BS Onpoint in Central NY denied me due to a excluded benefit clause-- "Services for weight reduction programs & Gastric Bypass Stapling for treatment of obesity." From what info I was able to gather there are a few other county employees who have had Bypass Surgery that the Ins. paid for, when I call bc/bs they say if people have had it they must have Paid the claim out in Error. One girl I know was originally denied Ins. coverage for a Dr. who performs Lap in Rochester who was considered out of "Network" but then was approved with a Dr. in Auburn who does the Open. BC/BS says since an exclusion I would not be approved w/ any Dr. even if it is a medical necessity, but am able to file an appeal. Anyone else seen a similar exclusion clause and if so any way around it? Thnx
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