Question:
Do I have a chance witj Unicare HMO?

My HMO has a very tough exclusion... it reads "Services primarily for weight reduction or treatment of obesity including morbid obesity, or any care which involves weight reduction as a main method for treatment. " I am just starting out and found out that this is really a hard thing to beat.... Do I have a chance? Or should I wait the 8 months until open enrollment comes around again and change insurace carriers to someone who will give me a better chance? My BMI is 54, so I am considered Super-Morbidly Obese, but the additon of Weight REduction as main method of treatment scares me! I do not have alot of Co-Morbids.... Asthma, incontience, undiagnosed sleep apnea and boarderline High Blood Pressure not requiring meds....... HELP ME PLEASE! Laura    — laura B. (posted on February 11, 2002)

February 11, 2002
Laura, that does sound like a tough exclusion, but my experience has told me the less said in an exclusion - such as - "Care & treatment for Morbid Obesity" are sometimes the toughest. You may want to search the Insurers section of this board and see if anyone with you insurance has had the procedure done. Perhaps you could also speak with a participating surgeon with your plan regarding the exclusion, they sometimes are aware of the intent of the wording of the exclusion. Good Luck,
   — Nene B.

February 11, 2002
I had a similar exclusion, but upon investigating it further, found out that medical necessity overrides any exclusion. You will need to fight it probably with an appeal, but you should be able to win. You should document any weight related problems that you have and enroll your doctor for help.
   — blank first name B.

February 11, 2002
A lot of companies have enrollment at the beginning of the thirs quarter too, and not just at the beginning of the year. Make sure you check that out too. It seems to be so much harder to get approved with HMO's, so it might be good to check that out, but there's nothing stopping you trying now! Just don't give up!
   — Deborah W.