Question:
Insurance exclusion for MO

My insurance - Alliance BC/BS of Missouri explicitly states "effective with groups first plan year..after Oct.1,1999, your program will no longer cover surgery for morbid obesity. All weight loss treatment and care for obesity will be excluded." Seems pretty iron clad. Would it be a waste of time to attempt pursuit? Should I just change insurance carrier? It is infuriating that because I can afford to purchase insurance, I am not afforded the same coverage that medicaid would offer!!!!!!!    — [Anonymous] (posted on June 3, 2000)

June 4, 2000
Does you policy have a general provision that covers procedures that are approved in advance as medically necessary? If so, then it is important that the procedure that you are having be described as the medically necessary treatment for whatever co-morbidities you have. In other words, if you have sleep apnea, then you need to say that this surgery is medically necessary for the treatment and cure of the apnea. Also, if you are denied, go through the appeal process and make a complaint to the insurance commissioner of your state. The issue will be whether the procedure is merely to lose weight or for something else - so document your co-mobidities very carefully! Good luck to you.
   — Kathleen B.