Question:
Exclusion for Weight Loss Surgery

If there is a clause that says "charges for surgical and non surgical treatment of obesity, including morbid obesity (such as gastric bypass surgery and gastric stapling.) These procedures are not covered regardless of the diagnosis. Does this include the Lap Band?    — reece1028 (posted on August 3, 2009)

August 3, 2009
It includes all and any treatment for obesity, sorry. but it never hurts to try. I would still have your doctor write a letter which includes your medical history. good luck to you
   — karrenn

August 3, 2009
Read your policy carefully. My pollicy has the same exclusion but if the surgery is deemed medically necessary, then the surgery is covered.My Ins is BCBS of Alabama, A PPO My Primary DR has to wrtite a letter of medical necessity. Keep researching. Those policies are hard to interpet sometimes. Call Customer Servive and ask questions. Also chose a WLS seminar to attend. They usally know about ins or call a dr's office you are interestd in and explain what type of Ins you have. Where there is a will their is a way.
   — polly_w15

August 3, 2009
It sounds like they will NOT cover any type of surgery for weight loss, maybe if they can say it's for other related health issues but don't count on that!!!!
   — rkurquhart

August 3, 2009
Just because your insurance doesn't pay doesn't mean you have to give up. It took me several years to come up with a solution, but I self paid. Check out several surgeons...the costs vary greatly. Just comparisome shop. One hospital I checked charged double what another did. I used what was left of my retirement...figured I wouldn't need it if I stayed morbidly obese anyway!
   — jtoothman

August 3, 2009
I'm currently fighting wih my insurance company. When I started the process back in March, wls was covered. April 1, the company changed the rules without telling anybody, including the employer. Right now, I'm filing an appeal. Good Luck in your journey. Believe me, I understand completely.
   — Kathleen W.

August 4, 2009
Hi. My company has Premera BC and the contract contains that same exclusion. In 2006 I wrote appeal after appeal to no avail. I figured out a way to pay for the surgery myself and am scheduled for 8/10/09 to have VSG. So don't give up hope. I have heard that some people are able to get around the exclusion and some arent. Give it your best shot and then look for alternatives (financing, stock options, etc.). Do what is best and works for you. Good Luck! Cin
   — Cynthia W.

August 4, 2009
Hi Oseenia. I am another that was denied by insurance. Mt company has BCBS og Ga. I went from HMO to PPo hoping my surgery would be covered. After 3 years and 40 pounds they still would not cover, even for medical necessity. Thankfully my son, daughter, ex-daughter in law and myself all chipped in and self paid. But do shop around. The cost varies so much. I even went to another town, 100 miles away and saved over 10,000. with a very good doctor and bariatric center. I even started to do the lap band which I did not want just to save money and my son told me I needed to get what I thought was best and not try to save and have to do it over. So when I first was approached with self pay, I cried, I had no idea where I could come up with that kind of money. But it happened, so don't give up!!! Pray about it. I even started to change jobs to a company that offered the surgery!
   — sallie H.

August 5, 2009
The truth is that if it is an exclusion on your policy, you are HIGHLY unlikely to get your insurance to pay. It is extremely rare. I get insurance approvals for weight loss surgery for a living and I tell people that if it is written in their policy as an exclusion, they won't pay for it because they don't have to. It's clearly written into the policy. But it is worth it! If you can find a way to self-pay, DO IT!
   — sandyriles