Question:
Insurance exclusion, do I still have a chance?

My insurance has recently told me that weight loss procedures are excluded from my plan (after previously having told me that they were); do any of you have the same insurance or a similar situation that has ended up for the better? I'm so scared that I won't be able to have this surgery after I got my hopes up and put a lot of time into research and planning. My consultation is supposed to be Tuesday, please help.    — Cathrine V. (posted on July 17, 2003)

July 17, 2003
I thank god everyday my insurance company was pretty easy. These insurance companies are getting worse and worse. The blues bcbc are dropping wls altogether i've heard. But, exclusions have to be written properly, and also put in the right section of the policy to be valid. Even then , like in NY, the policy is to cover something when it is medically necessary even if it is excluded. Check the law in your state. Then, check the policy. Does it say obesity, or morbid obesity? or just weight loss surgery. WLS is not clear. This surgery is also performed to alleviate co-morbibities. You could get around the exclusion that way. Any questions let me know, but keep fighting, don't give up.
   — gary viscio

July 17, 2003
Catherine I feel for you. I hope things work themselves out. In the mean time, you may want to check the website question archives for some answers. This question pops up quite a bit. Many of the archive answers have tips for dealing with your situation.
   — M B.

July 17, 2003
Cathrine, don't call your insurance co. They lie. Look at the exclusions in your benefits book, and see what it says. Insurance company employees are trained to tell you that whatever you need is not covered in the hopes that you will just go away. I'm not saying that your policy does cover WLS, because I don't know, but just don't call your insurance co. If your surgeon is in-network, let them deal with insurance...they're used to the games.
   — Leslie F.

July 17, 2003
Catherine, I had BC/BS of Maryland and I also had a written exclusion. Fortunately for me, Maryland is one of the states that has written into law that WLS surgery must be covered if medically necessary. You might want to check out the laws in your state. I know that there are about 5 that have this mandate, maybe yours will be one of them. Good luck to you.
   — Pambylah

July 18, 2003
'Insurance company employees are trained to tell you that whatever you need is not covered in the hopes that you will just go away.' -- OMG!!!! I guess that could be true with jobobjimmies insurance company....but not of all. Wow. I worked for UHC for years and it is thier policy and one that is preached down to everyone...that if you have any way possible to get that claim paid...pay it. In no way were we ever told to lie, or deny coverages so we could get out of anything. Each insurance company has a kabillion different policies, and just as many ways to look up the coverages on each one. I can see how confusion can happen....but to intentionally lie to get out of paying on a claim....
   — RebeccaP

July 23, 2003
Catherine, first of all, good luck to you. I had nothing but problems with UHC, I never got a consistent answer from them and we're still arguing it out. I was beyond patient, now I'm just mad. To everyone's credit, I do believe that every experience is different. You may want to check out www.insure.com, they have some great info....especially on the laws as they pertain to each state. GL to you, I know it's a frustrating process, but Where ther's a will, there's a way!!!! :0)
   — SweetDragonfly