Question:
IS THIS EXCLUSION AIRTIGHT

My insurance policy is BC/BS PPO. In the exclusions is states: " Services or supplies related to obesity, including surgical or other treatment of morbid obesity." I also have several comorbidities, HBP, High cholesterol, depression, arthritis, ect. Am I fighting a losing battle with this exclusion?    — TONJUA A. (posted on April 4, 2003)

April 4, 2003
I don't believe it is air tight. Go for it. All they can do is say no and you still have the appeals process. Good Luck! Sincerely, Mary Beth
   — Beffy W.

April 4, 2003
I have a similar policy on my primary BCBO of Oregon coverage. It's the kind of policy you or your employer purchased. (Check to see how low your yearly deductible is) My employer simply purchased a policy with that exclusion. Yup, pretty air tight. Sorry. Do you have a secondary policy through your spouse that might cover it? Good Luck
   — Terrie G.

April 4, 2003
I have BCBS of NC PPO, make sure you read it in its entirety, because mine says it does not cover services, supplies, drugs or charges that are for treatment of obesity, EXCEPT for surgical treatment of morbid obesity. I would fight it regardless-your life is too important not to! Wishing you all the best:)!
   — doit 2.

April 4, 2003
There is a lot worse that can happen besides them saying No, in my opinion. You can get stuck paying thousands of dollars worth of pre-op tests that the surgeon generally requires you do before they see you. My husband has insurance through BCBS of Oregon. They have an AIRTIGHT exclusion to ANYTHING related to weight loss. I wasn't aware of that when I started looking into this procedure two years ago, and so I did what the surgeons office told me to do. Nutritionist, Sleep Study, Pychologist..... THEN I got a letter stating nothing would be paid for. I'm not trying to sound harsh here, but I suggest you really read through the policy before starting any testing or even meeting with the surgeon. Getting stuck with $3000.00 worth of bills was not fun. Thank God I have new insurance that is covering everything at alomst 100%. Good Luck.
   — J. Wilkinson

April 4, 2003
I dont have bcbs I am on United Healthcare PPO and they have the same exclusion Surgical and non surgical treatment for obesity (morbid obesity) is excluded and I called them and talked to them and they said that I could have the doctor turn in my paperwork and because of my medical history would probably be approved. I would call them and talk to them before you give up hope and there is always appeal processes. I would think though that the insurance company would rather pay 20000 than a lifetime of hospital and other expenses. good luck:)
   — harleigh2002

April 19, 2004
You didn't mention what state you live in but some states have state mandated laws that make the insurance companies cover the gastric bypass under certain conditions. I live in Maryland, and though my insurance (MAMSI MDIPA)states the same exclusion as no coverage for morbid obesity, they neglect to mention that our state mandates by law that if you are morbidly obese and have comorbidities because of it, then they have to cover because of the conditions it is causing, not the obesity. The insurance companies neglect to inform of this hoping you won't research and will accept it isn't covered. Check your state laws on the internet and check with the insurance commissioners for your state. Wishing you the best of luck.
   — Alison K.

July 25, 2005
bcbs OF SOUTH CAROLINA, Any medical Supply or service rendered to a member for the treatment of obesity or for the purpose of weight reduction. This includes all procedures designed to restrict the Member's ability to assimulate food, such as, Gastric bypass, the insertion of gastric bubbles, the wiring shut of the mouth and any other procedure the purpose of which is to restrict the ability of a Member to take in food, digest food or assimiliate nutrients. Sounds like there maybe a way to go around this with the lapband in my opinion. I'm not a lawyer nor do I play one on tv.
   — Florence B.