Question:
BC/BS Onpoint exclusion??

BC/BS Onpoint in Central NY denied me due to a excluded benefit clause-- "Services for weight reduction programs & Gastric Bypass Stapling for treatment of obesity." From what info I was able to gather there are a few other county employees who have had Bypass Surgery that the Ins. paid for, when I call bc/bs they say if people have had it they must have Paid the claim out in Error. One girl I know was originally denied Ins. coverage for a Dr. who performs Lap in Rochester who was considered out of "Network" but then was approved with a Dr. in Auburn who does the Open. BC/BS says since an exclusion I would not be approved w/ any Dr. even if it is a medical necessity, but am able to file an appeal. Anyone else seen a similar exclusion clause and if so any way around it? Thnx    — Tom C. (posted on February 5, 2003)

February 6, 2003
I had the same problem with BC/BS of TN. Your employer probley put an exclusion in Jan 1,2003. It saves the company money each year to add WLS exclusion. My employer saves close to 100,000 by having added a exclsion against wls. You need to appeal. You can also call / fax/and write your State Dept of Comerce and Health (you can find all phone# Fax# and address on the net. ALSO contact your "State" dept of health and file a greivence.When you appeal also state that you have contacted the above and will go futher if needed. Don't forget to mention the (ADA) the Americans with Disibilitys Act. It's discrimination to be turned down for a procedure because it is related to obesity. Obesity is a disease! If your policy will pay for drug and aclohol rehab than how can they exclude something that kills over 300,000 people a year? FIGHT FIGHT FIGHT.... I AM!!!! -L
   — lnelson