Question:
Healthmarket/ PHCH MD Plan exclusions

HELP!!!!!!!! Need advice from anybody on PHCS MD Plan as I am desperately in need of help with them. My policy started 12/1/03 thru Healthmarket/ PHCH MD Plan and they say they have a written exclusion to Bariatric surgery. The exclusion is very vague and only mentions weight loss not specificly Bari...The 1st Dr. I tryed completly backed away from assisting me when they heard there might be a fight (the plan also states that no referral or preapproval is needed). I later contacted The BTC, their Dr & staff said they didn't think I would have trouble (because of BMI 52 and several other health problems)but after a call to PHCS & a visit with their local insurance rep at my office , they wouldn't budge. Could you please email me : [email protected]. and tell be how you might have gained approval with this company & also maybe copy me on any sections on your policy that might imply excludion of coverage. PS I would also like to know if any one has had success thru a legal service like obesitylaw.com, Thank you very much, Pete B.    — Pete B. (posted on December 28, 2003)

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