Question:
Ins excludes charges for treatment of obesity/weight reduction

In the exclusions, it specifically says: charges incurred in connection with services or supplies provided for the treatment of obesity and weight reduction. Has anyone had this same exclusion, and still been approved because of MORBID OBESITY?????????    — Tammy P. (posted on July 17, 2000)

July 17, 2000
<i>POST IS FROM Stephanie L. ([email protected]) but for some reason I couldn't post from that!</i> My insurance has the same exclusion, but it seems that MORBID obesity is a completely different matter. It all comes down to a determination of medical <b>necessity</b>. My PCP gave me the referral, and the referral coordinator was almost rude when she pulled out the policy to show me the exclusion. But I had already spoken with the actual insurance company, and told her so. She still didn't believe me and said, "Well, no one will begrudge you a consultation with the surgeon, but it's not going to be approved." Then, right then and there, she called the surgeon I was first referred to, and to my delight, the surgeon's assistant informed her that it is covered. So fight, fight fight. 13 days and counting...
   — Luci L.

July 18, 2000
Tammy, My insurance reads the same as yours, and I was approved. However, some of the services I needed to go along with the surgery were denied because they were coded as being "for the treatment of obesity". For example: the dietician. I argued with the Insurance Company and I argued with the hospital. One says it won't pay because they don't cover services for obesity. The other refuses to change the way they code it. I told the hospital they'd get paid if they'd just somehow code it so the insurance company knows it is to teach me how to eat after this surgery with a 2 oz. stomach pouch - but I cannot get either to budge. Therefore, I decided not to see the dietician anymore even though my surgeon wants me to. My surgeon is aware of this and has decided to live with it.
   — Cindy H.

July 18, 2000
I too have the same exclusion with my insurance. (Just found this out today) I'm hoping that we can use the MORBID OBESITY as a loop-hole.....OR....If we can somehow say that the surgery is not done for the main purpose of losing weight, but weight loss is certainly a side effect...hmmmm...it could happen, right? Anyway...I'm just grabbing for any possibility right now. As I'm sure you are. Best Wishes!
   — Lee B.