Question:
insurance

I have pararmount hmo for insurance. I was told by pararmount that where I work at has a clause and my plan does not pay for the surgery. Can I get this over turned?    — jmhall (posted on July 26, 2006)

July 26, 2006
Hi Joyce! After dealing with insurance companies, all I can say is that if they told me the sun rises in the east, I'd get up at 4 AM with a compass to check it out! Am I accusing them of lying? Uh, do you see any resemblance to a rug? I suggest that first, go talk to the insurance coordinator at work and see if he or she knows anything about this exclusion. If such a clause does exist, ask the reasons, and if they can't come up with something legal, try getting loud and obnoxious about discrimination. There is a time to be a lady, and a time to be a screaming fool. I'm feeling a little militant today, and I realize that we have the "oh, it must be my fault" mindset, and we let others push us around because of it. Stand up for your rights! If necessary, write to your state Commissioner of Insurance, and see if this exclusion is legal or not. Good luck! and I'll keep you in my prayers. --Mary
   — mwilson523

July 26, 2006
I would have to say, step slowly. If you signed a contract with your insurance carrier and it states that it does not cover WLS then there is really nothing you can do. Unfortunately, NO ONE reads the entire book when signing for insurance. It is a matter of asking the right questions at the right time. I had AmeriHealth Personal Choice, that would have paid for the surgery with a simple letter from my GP. I switched to Aetna, NEVER asked if it would cover WLS. Turns out they do cover it but for very specific medical reasons. After 18 months of appeals I was covered. But, if it had stated that it DID NOT cover WLS, I do not think there is much I could have done. We just switched at work again, this time I asked the insurance broker VERY SPECIFIC questions about what is covered and what is not. I found out it is the same plan, still Aetna, but the new plan does NOT cover Sexual Enhancement Drugs(Viagara). Other then that I have a higher co-pay but a lower weekly payment. Lucky for me I am not yet at a point where I need those drugs, but if I had not asked I would have never known. If the contract states it does not cover it, I don't think it will do any good to make a scene. Investigate, find out the EXACT terminology in the contract and know exactly what you are facing before causing a scene. It is always best to investigate your enemy before going to war.
   — WMKaisla

July 26, 2006
I have been going through the same thing and the insurance rep told me I could file an apeal but I would be apealing something that does not exist. We had this conversation about what if it meant I would be dead if I did not have the surgery and he plain and simply told me it was nice knowing me. I have researched and researched but if the provisioon ain't there it ain't there. If I get cancer from smoking it's covered. If I get hit by a car because I crossed infront of it I'm covered, but to loose weight so I live longer.......no way to change an HMO(hand money over).
   — sandra J.