Question:
My insurance has the exclusion no obesity/weightloss surgery

What can I tell my employer? to make them change. In my case I work for a very large school dist. and I'm sure "IT'S A MONEY ISSUE'' I am willing to try anything, but knowing how they are it seems hopeless. any suggestions welcome!!!    — Cindee A. (posted on March 20, 2001)

March 20, 2001
Cindee! Don't succumb to hopelessness! I'd suggest you check out the Library - lots of info there. Proceed as though there is nothing that can stop you. Make whatever appts. need to be made. When and if you get to the ins. exclusions/denial stage there is an attorney who is an advocate for us. He's been there and knows the score. I believe his name is Walter Lindstrum (or something like that!?!) and his website is http://www.obesitylaw.com I think! (I'm lucky I know my name sometimes but others on this site can steer you to him if I'm wrong.) Never give up! Write whenever you need cheering up or info. There are so many wonderful, knowledgeable people here willing to help if you just ask. Best of luck!
   — Lynn E.

March 20, 2001
My policy BCBS had an exclusion also for Weight Loss incluidng surgery and I was approved in two days. As long as you can show that it is medically necessary they will pay. I had several doc letters, i wrote a personal letter, even my husband did and we had no problems
   — Gail M.

July 8, 2002
This is a self-funded plan offered to state of Texas employees w/the same exclusion you posted. I've been working w/the group at COMPASS, used to be IMAGES, and they've confirmed that the BCBS-TX exclusion isn't iron-clad because the medically necessary clause has worked, and they're working with me to get approval based on that. I know there are several who've tried to get past this based on a LOMN and were denied, but my case-worker lady seems confident based on the information provided by her contact at BCBSTX. See below: Dear Lynda, I spoke with Lettie at Blue Cross today and was told that they will consider this surgery if medically necessary, however as you have an HMO they will not allow you to go out of network. I noticed that you stated that you will roll over to PPO in September. I would suggest we wait until after September 1 to submit the letter of medical necessity for approval as they will certainly deny it due to being out of network. Please let me know how you would like to proceed and thanks for letting us know that they will consider this procedure. Up to now we have always been told that this was a "definite exclusion" on this policy even with medical necessity. Thanks and I look forward to hearing from you. Sheridan at Compass GOOD LUCK EVERYONE!! :)
   — Lynda L.