Question:
Has anyone been approved for WLS even when their policy states it under exclusions?

After reading my policy I found gastric segmentation, weight loss surgery, along with numerous other treatments such as those for infertility neatly stacked under exclusions! I am sure that I'm in for a FIGHT!    — Beth Preston (posted on November 2, 2000)

November 2, 2000
You are right you are in for a fight,but people do get approved even with exclusions. You have nothing to loose while fighting and continuing to look at other options just in case. I say Fight Fight Fight! I did and lost but I changed Insurance Plans ASAP, then I was approved.
   — Tamaria W.

November 2, 2000
My insurance, BC/BS of Florida, preferred patient care, PPO plan, stated in my book that "any service or supply to lose, gain or maintain weight including surgery is excluded" My surgeon's office suggested I call. They gave me the diagnosis code# and the procedure code # and told me to ask them if it was covered. Low and behold, when I called they said the procedure was covered pending proof of medical necissity and a letter from doctor stating medical necissity. We went ahead, submitted everyting and I was approved 3 days after they got all the documentation. I believe that they put that vague language in the book to stop alot of people right then and there, knowing that alot of people will never investigate further. Also I think it has alot to do with the fact that morbid obesity is an entirely different category than obesity or overweight.
   — claire C.

November 3, 2000
I am where you are and fighting all the way. Check out my profile to see where I am in my battle to win this war for everyone.
   — richter454