Question:
MEDICAL EXCLUSION what is this.... I feel like crying

called the Insurace Humana they said there is a medical exclusion in the contract they can not do anything the surgery is not covered...I am so tired of this rollercoaster of a ride maybe this is not for me.....HAVE THIS HAPPENED TO ANYONE AND WHAT WAS THE OUTCOME...please advise    — lastchance (posted on January 26, 2006)

January 26, 2006
Hi Nicol, I cannot say this has happened to me, but, from reading others' response on this board-it has happened to them. From what I recall, if you plan is self-funded, which means your employer pays for the insurance (i.e. you do as well then) then this exclusion is not the end of the road for you. I believe sometimes people are able to go to their HR dept or whomever handles their insurance, and speak with them about getting approved for the surgery. Sometimes,all it took was one phone call from the HR to Humana-and the approval went through. I hope this helps-just keep fighting. Go see your HR people, or your plans administrator. Find out if you're self-funded or not. Good lUck!
   — Meghan R.

January 26, 2006
Hi Nocol, I am going through the same thing right now with Cigna Insurance. I just submitted my 4th appeal yesterday. I know how frustrating it is, people keep telling me not to give up but I am beginning to feel like it is hopeless. I went to my HR Dept and got zero help...I've heard the insurance companies do this hoping that you will give up...so just keep trying! Hopefully you will get the answer you want soon!
   — MichelleInAZ

January 26, 2006
I had an exclusion that was unbeatable----no way would they help me----others here have beaten an exclusion---so its best to check with HR where you work and see what the deal is. I then went to vocational rehab in my state--you would have to look up your state office as well and contact them regarding any help with your surgery. In my state they will help but will hold a person responsible for a portion of the fees depending on salary. I will be forever thankful to them and their help----so don't give up---there are still possibilites---nothing this good---comes that easy--at least for me it didn't! Best wishes and keep your chin up! Lisa
   — Lisa4kds

January 26, 2006
I have concluded that if all else fails that I will self pay, for 13k all expenses, I can go to Brazil or Mexico to one of the world best doctors , and get the best procedures of the three choices, the DS, come to the DS forum, and ask about self pay, even on a credit card that less than 300,per month. for a better life.
   — walter A.

January 26, 2006
My company also had an exclusion and I contact Kelley Lindstrom at Obesitylaw.com. Please read my profile for my story and if you have any questions, call email me. They are very upfront and will let you know after chatting with you and reviewing your information if they can help you or not. Any they are very reasonable price wise. Good luck, it's worth the fight. (RNY LAP 12/17/04) -120
   — jenniferw

January 26, 2006
My company also had an exclusion and I contacted Kelley Lindstrom at Obesitylaw.com. Please read my profile for my story and if you have any questions, just email me. They are very upfront and will let you know after chatting with you and reviewing your information if they can help you or not. Any they are very reasonable price wise. Good luck, it's worth the fight. (RNY LAP 12/17/04) -120
   — jenniferw