Question:
What should I expect when my insurance's exclusion statement is so specific?

My insurance carrier is UHC Select EPO (Southwest Airlines). The exclusion reads "Gastric Bypass Surgery as a form of treatment for severe or morbid obesity is not covered". When I called the insurance company and asked under what circumstances is the procedure covered, the CSR stated that based on an "alert" that is posted on her screen, effective June 14th, 2002 the procedure is not covered under any circumstances not even medical necessity. When I asked why I never received this change to the benefits contract she stated that is the responsibility of the employer to do so. Can anyone shed some light on what my next course of action should be?    — kbeckzpb (posted on July 30, 2002)

July 30, 2002
Karen, sounds like they have you pretty good. I must say I am not surprized that Soutwest Airlines do not care about the Obese. I wish I had an answer for you. If it were me I would either look for another way, or call a lawyer. Good luck.
   — Pam G.

July 30, 2002
Karen - Their new answer sounds almost identical to the original exclusion. I don't see where there was a change in the benefits contract. I wish you luck but it looks like no matter what the answer is no.
   — Deborah R.

July 30, 2002
It looks like it's time to find a new employer w/better insurance. Good Luck
   — Marian K.

July 30, 2002
Another not-so-positive comment- Unfortunately, it states your answer quite bluntly. The only way you could have possibly gotten around it is if it said for the obese and not said specifically MORBID obese. When they say it is not covered even when medically neccesary, it's a done deal. I personally would not spend the time and money on an attorney. All you can really do is look for another job with better insurance, Sweetie. I'm sorry- I hope I am wrong...
   — karmiausnic

August 1, 2002
My insurance policy had a specific exclusion also that stated something like "will not cover surgery or treatment for obesity or morbid obesity even if medically necessary. I even called my insurance company to make sure, and they told me the same thing. Well, I submitted the paperwork anyway and it turns out they take them on a case by case basis and review them. I was approved in less than 3 weeks and I had my surgery December 12, 2001. Of course they are going to tell you that the surgery is not covered, it is a very expensive surgery. I would send the paperwork through anyway. What have you got to lose??
   — Melinda B.