Question:
Can you get past an insurance exclusion

My insurance says excludes treatment for weightloss including but not limited to gastric bypass, stapling, etc. Has anyone got past that exclusion? How? I have American Medical Security PPOM insurance.    — stephanie418 (posted on February 6, 2003)

February 6, 2003
Although I have not been approved yet, my insurance also has weight loss surgery listed as an exclusion. My surgeon, Dr. Wanda Kaniewski informed me that my employer/insurance company is required in the state of VA to make surgical treatment for morbid obesity available to me by law. This does not mean that you may not have to pay for an additional rider to be added to your existing policy, but it does mean you have options. When I called my company's HR dept to inquire about the process to appeal, they were very forthcoming in giving me the information and letting me know that another emploee had already appealed for WLS and was approved after only 1 appeal. Check the law for your state and ask your HR dept if anyone has ever successfully appealed the exclusion. Hope this helps!
   — Nancy R.

February 6, 2003
I don't know if this will work or not, but I'd advise you to go to the doctor for EVERYTHING! If you get a back ache, go to the doctor. If your knee hurts, go to the doctor. Get the picture? The more you have documentation and the more THEY have to spend on you, maybe they'll get the picture that it may be cheaper to give you the surgery. Don't know if it will work, but that's what I would do.
   — Robby E.

February 7, 2003
My BCBS policy also has an exclusion; however, I was approved on the first try because of co-morbidies.
   — dottykay