Question:
Solid exclusion or not?

Under exclusions, my policy states, "Weight reduction treatment, surgery or drugs (including appetite supressants). Would this be a solid exclusion?    — Mary S. (posted on February 27, 2004)

February 26, 2004
It reads as though they won't cover ANY weight reduction methods. But I would call your provider and ask just to be positive they can tell you for sure. Good luck.
   — Vitabella

February 26, 2004
Mine basically said the same thing, but they wound up paying for the surgery anyway. It's worth having a doctor send in a letter of medical necessity in just to see. Especially if you have medical conditions that are caused by or aggrivated by morbid obesity. Just go into it knowing there is a fairly big chance you will be turned down, I know it's hard not to get your hopes up. I wish you the best of luck.
   — issymudd

February 27, 2004
You're not having weight reduction surgery, your having surgery to reduce your obese or morbidly obese condition, AND to releive or alleviate the symptoms of co-morbid condition. So no, my opinion, nice try, no exclusion. Check out your State law, but these exclusions need to be very specific and here in New York and some other states, exclusions do not apply if the surgery is medically necessary. In other words. Fight 'em
   — gary viscio

February 27, 2004
I agree to fight it. I tried with my United Health Care exclusion, but their exclusion is the worst. Also, talk to your employer. They my have the power to make an exception to their policy rules. My employer is self-insured and will not cover the surgery. Try your best and fight it. It has worked for others.
   — Terry Lynn W.

February 28, 2004
Go for it anyway and appeal if denied. As some of the other posters have said make sure your doctor submits a letter of medical necessity. Those exclusions are set by your company and not the insurance co. My sister has UHC and was approved after the 1st letter with no problems. She never had to contact the ins. co. at all. Good Luck!
   — jacquie-dee