Question:
Does this exclusion include morbid obesity?

Here is the exclusion in my policy. Cank someone tell me if it also includes MO since it does say gastric bypass? "for weight control or treatment of obesity, even if medically necessary, including but not limited to gastric bypass surgery and other surgery for obesity; for reversals or revisions of surgery for obesity, except when required to correct an immediately life-endangering condition". Thank you! Kelli    — kelli4wls (posted on September 28, 2006)

September 28, 2006
That definitely sounds like it includes MO, but the best thing you can do is call your insurance company and have them explain more thouroughly. My insurance company also said something close to that, and turned out they did cover it you just had to jump through many many hoops. In the end I ended up going to Mexico for my surgery. Good Luck!
   — kimmy

September 28, 2006
Hi Kelli, I went to your profile and read it. It sounds like to me that you and your husband don't hardly own anything, so I am going to make a couple suggestions to you. Drop Blue Cross if it doesn't cover the surgery which it sounds like it doesn't by your post. Now I hate to have to suggest the next part of this because of such bad talk regarding this type of insurance, but why not try Medicaid. They will cover it as far as I know because that is what I am on and from what I have heard from my social worker, as long as it is "Medically Necessary" they will cover it. Now I know that a lot of people call this "welfare insurance" but it really is the best type of insurance if you have no job, home, etc. I am sorry if this offends you but I am only suggesting this in support of you getting the surgery and wish you good luck with your journey.
   — C. Reed

September 29, 2006
I have to say that I disagree with the poster who suggested you try to get on Medicaid when you have the option of being on private insurance. First of all, there is only a limited amount of money to fund medicaid and if people who don't need it use it, those who truly have no other option may be unable to get the medical care they need. However, should you lose your health insurance and meet the guidelines, go ahead and apply because that's what it is there for. My experience with Medicaid has been that they are very selective on what they will cover. They tend to try and stick with the immediately life-endangering guideline for everything... surgery and otherwise. Depending on your state, they tend to cover less than private insurance and what they do cover, you have to jump through more hoops in order to get it. It sounds like the exclusion on your policy includes MO and that you will be unable to get the surgery covered. Obesity is the generic term for being overweight and morbid is just a word that describes the severity of the problem. For example, if this were about diabetes and it said it excludes treatment for diabetes, it wouldn't matter if you had mild, severe, insulin dependent, non-insulin dependent, because its all diabetes... the same thing with obesity and morbid obesity. I do wish you luck and hope that you are able to find a way to get this surgery done. There are several methods of financing the surgery, including low interest medical loans if you are unable to get any funding. Best wishes to youl.
   — mrsidknee

September 29, 2006
Thanks for the advice, but I really can't apply for medicaid at all. My husband makes too much for us to qualify, but we do not make enough to pay for the surgery. We are stuck between a rock and a hard place I have thought about going to Mexico, but even then, I will need to save for a while. Kelli
   — kelli4wls

September 30, 2006
Kelli, I was in the same position as you and I was determined if These insurance companies kept it up I was going to Mexico, I had a change pig on the inside of my front door and everyone of my friends and family that walked in every day stopped first and took all the change out of their pockets and put it in the pig But guess what I didnt have to go to mexico, I changed insurance comanies and went to my surgeon for the first time and I had my surgery within a month of being on the new insurance and they approved me within an hour with no info from my pcp or anything! Lets talk!! Email me privatly and Ill tell you everything! [email protected] Kim N
   — witchywoman