Question:
Treatment of obesity exclusion in policy?

My insurance starts on Nov.1, 1999 and when reading through the policy that I just got in the mail today, it is mentioned several times that "Treatment of obesity will not be considered treatment of an illness." and also under the Benefit Details section it says "Benefits will be paid only if the Covered Expenses are:for services and supplies that are:Medically Necessary. Under the section "What's not covered under the C/MM(Comprehensive/Major Medical)" it says "treatment for obesity" again. Well on to my question. I need to know if anyone has come across this problems and when filing for pre-approval, do you think or have you had experience that there has been approval after appeal in situations as such when using my co-morbidities as a reason for WLS? Sorry this is so long I really need to know. Anyone interested in chatting privately please mail me at [email protected] Thanks Char Gibson Tulsa,OK USA Age 28/5'7"/410/BMI 66.4    — Char G. (posted on October 14, 1999)

October 14, 1999
Hi, I had surgery in Oct. 1998. At that time I had Blue Cross Blue Shield HMO Colorado. The first time it was submitted for approval I was denied. I had diabetes, and high blood pressure. I appealed this decision and was approved the second time. I had all my doctors write letters and send them to the surgeon's office and they submitted everything to my insurance company. Good luck.
   — Kathy K.

October 14, 1999
I have Great West PPO. So far, I have not had a problem. My policy is company funded, but I don't think that should make a diffrence. From day one we have pushed all the other problems associated with being morbidly obese. I need medication for blood preasure, I have Sleep Apneia, my BMI is high and I have a lot of joint pain in my legs. My surgery has been approved and is scheduled for 10/29/99. I don't have the address but look up the web site for Walter Lindstrom of San Diego, Ca. He is a lawyer who deals with obesity discrimination. He has a lot of information on his site dealing with what to say to get approval. Thanks, Joe Wlodynski
   — Joe W.

October 15, 1999
My Policy also has an exclusion for treatment of anything related to "obesity". However, if surgery is an option for you then you have "Clinically Severe Obesity" aka "Morbid Obesity" (ICD9 278.01) This is a disease, and if your policy just excludes "obesity" it may very well cover the disease "Morbid Obesity". THERE IS A HUGE (no pun intended) DIFFERENCE!! Good Luck!
   — Morgan B.

October 18, 1999
Hi Today i was approved. The pending case manager told me that as long as you meet the requirements and submitt all the paperwork you'll be approved. Maybe you could call the insurance company and talk with them. They were very helpful to me.
   — Mary C.

April 7, 2000
Hi, I have Great-West insurance but, HMO. My primary doctor has requested my surgery. So far things are going well. I am a diabetic and I have hypertention. I did make the first call to them and they where very understanding and helpful. They do have some requirements such as a mental evaluation. I am in my first steps, but so far so good. I also live in Washington state, I don't know if that matters. It has been some time since you Char have asked your question. I hope your concerns have been met. Rita, Everett, Washington
   — Rita L.