Question:
My insurance has a exclusion for weight loss surgery, but can i get around it?

it reads. surgical or invasive treatment, or reversal thereof, for reductionof weight, regardless of associated medical or psycological conditions, including treatment of the complications resulting from surgical treatment of obesity. I though out first I was out of luck, because of the medical and psycological, but it says obesity not morbid or past. what do you guys think.    — Diana H. (posted on September 9, 2003)

September 9, 2003
Oh boy... it says, "surgical or invasive treatment...for reduction of weight" that INCLUDES morbid obesity... obesity of any kind, actually. The only way you could get help from them is if you ALREADY had the surgery for morbid obesity and needed help with complications from it... simply becasue they only stated "treatment of the complications resulting from surgical treatment of obesity." They have a pretty airtight exclusion written here... that first section I quoted from you in the beginning is what seals it tight. You can try, but I can give you a 99.9% probability that you won't get anywhere with them. I'm sorry.
   — Sharon m. B.

September 9, 2003
hi diana - i too have an exclusion on my policy with humana ( ppo ),. i tried anyhow. waited six months , went to a mandetory seminar , then to the weigh in , where after this they submit for approval . well if course i was denied , stated because of the exclusion . most everyone will tell you , if there is an exclusion , they are pretty well set in stone . there will be new policies coming for review this month because the new policy year starts oct. 1 , 2003 . so i am hopeing it will be covered this time , or at least on their hmo , i am checking all policy choices . when i called humana before about the coverage , most said it would be covered , but acouple said NO . guess they knew what they were talking about . now if it says with the exclusion , must be medically necessary , then you have a chance . sorry , but i know how it feels ........ good luck .
   — patti G.

September 10, 2003
As a Licensed Life and Health Broker in the State of CT, I can honestly say that the insurance carriers put exclusions into policiy contracts becuase they do not want the inceased exposure or rick associated with a specific disease. The only thing that might be able to helpis if you write to the Insurance Commissioner in your state and make them aware that the insurance company is dicriminating against a specific disease especially if they have no exclusions regarding smoking, drug abuse or mental health problems. It looks likes the language in the exclusion is also covering their BUTTS in regards to complications because then this would be a PRE-EXISITING condition and most Individual carriers DO NOT cover PRE-X conditions. Try to switch plans and see if a new carrier would cover the surgery if the Ins Comm cannot help you.
   — Elaine S.

September 11, 2003
If I were you I would look into the state Insurance commision. They all have guidelines that allow you to request an independent review of the insurance facts and your medical records. This does not include some insurances that are governed by ERISA on things through the state. check into it the people in the state office can be very helpful. If the independent reviewer says the surgery is medically necessary they can actually make the insurance pay for it. Good Luck Becky Jo
   — becky M.