Question:
I was told flat out that WLS was exclused from my health insurance.

I called tonight to find out if WLS was covered by my health insurance. I was told flat out that WLS was excluded. Are there exact questions that one should ask to get a different answer? I can say that I was probably very vague in my question. I live in Arizona, work for Banner Health and have Schaller Anderson Insurance - Advantage Plus. I am at a 37 BMI, 5'7" at 245, with hypertension, high cholesterol, tingling limbs and I could probably come up with a couple more co-morbidities if necessary. Any suggestions would be quite appreciated. You can e-mail at [email protected] or post an answer here. I think I will be spending a lot of time here. Thanks much.    — Judy H. (posted on July 18, 2001)

July 18, 2001
get the exclusion in writing and see if it says weight loss surgery is excluded for the treatment of "obesity" or does it say anything about "morbid obesity" as these are two very different things.
   — Cindy H.

July 18, 2001
Judy, I too was told that WLS was excluded from my insurance... they stated this was "Just not covered" then I called back and was lucky to get another representative and she quietly told me that they have a department within my insurance that if my doctor request to go through they have to investigate and it goes before a panel for approval... it was called the "utilization Management dept." so, look inside your insurance and ask questions! Good luck!
   — rinkadinktx

July 19, 2001
I have a friend that had the book and the exclusion was in writing and because she had a BMI over 50 they approved her at 70% because it was out of network! You never know the miracle the Lord can do and it does not matter what the insurance says if this is His plan for you it will be approved! ALL THINGS ARE POSSIBLE, FIGHT FOR YOUR BLESSING!
   — Kim M.

July 19, 2001
Appeal.. document and be persistent. Get support from your Dr and any other physician you have seen. Get tested for comorbidities.. check blood pressure, diabetes, thyroid, sleep apnea etc.. Good luck.
   — Dawn R.

March 2, 2002
I have BC/BS-Blue choice PPO of OKla. I called the other day to see if I had been approved yet and they flat out told me It was not covered, it was an exclusion. The weird thing is, my friend whos hubby works at the same company as my hubby got approved, but she has blue links HMO. I dont get it.. I am paying more a month for my insurance you would think I would have a better policy on it. Anyway Im going to try to get more paperwork together and see if we can change their minds... T Frazier
   — sugarbugz

March 2, 2002
The posters who have said to get it in writing are absolutely correct. I was told over the phone that it was not covered. I said I wanted to see it, so they sent me a copy of the page. It is in the 'exclusions' part of the book, but after it said they don't cover treatment for obesity as it is not a 'disease', it says they do cover surgery for morbidly obese under certain conditions. Nearly anyone who is MO can meet those conditions.
   — [Anonymous]

July 8, 2002
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.