Question:
My company has excluded obesity and weight loss treatments

They have named every procedure in the SPD but it does not say MORBID obesity. Do I still have chance? Also, we are changing to CIGNA at the beginning of the year. I am not sure if I should persue WLS on my current path (Sagamore) or wait until the new ins is in effect before I try. We currently write our own policy.    — J. D. (posted on November 17, 2001)

November 17, 2001
Unfortunately, it sounds like your company is "self insured," which means they can do what they want basically. Even if they change to Cigna, they will likely still be self-insured. My company was self-insured, too, and had an exclusion for weight loss surgery, but they did say, "unless morbidly obese," so that was the fortunate thing. They approved me within a few days. Good luck to you.
   — Terissa R.

November 17, 2001
My insurace said these exact words "Medical Expenses Not Covered" Treatment of obesity, except surgical treatment of Morbid Obesity when the patient's weight is at least twice the ideal weight. And I was approved with in 1 week. I think if it only states "obesity" and not "morbid obesity" you will be just fine. Hope this helps, and Good Luck! PS I would wait for the CIGNA to come inforce. Because insurances can take long and so can a doctor to give you a date and we are in November, already.
   — Nora R.

November 17, 2001
Hi Jay, My hisbands insurance also said that it would not cover any kind of weight loss help, pills or surgery! But after a long seven month battle showing them that this really was medically necessary, I now have a surgery date! I had to keep on the phone with insurance and the doctors office, butit DID pay off in the long run!
   — Lori D.

November 17, 2001
Hi Jay The company I work for had an exclusion in their policy but all I had to do was go to the benefits rep with a Dc9 letter from my surgeon they then ok me. I have Cigna HMO which then denied me a second time because of no medically 6 month doctor supevised diet. I know three other people in my area that got from Cigna for the same thing so if you are going to switch to Cigna start a diet know with your doctor. I did finally get approved.
   — POOBEAR

July 8, 2002
This is a self-funded plan offered to state of Texas employees w/the same exclusion you posted. 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.