Question:
WLS approval despite clearly stated WLS exclusion?

I was reading through my HMO plan description and was disappointed to read in *bold* print that WLS will not be covered under any circumstances. Has anyone recieved an approval despite these clearly define terms in their own (or the same) policy? My BMI is 50, I suffer from sleep apnea and my father is a 2X diabetes amputee. I don't have an extensive "diet" history, but my PCP certainly has records of my weight "yo-yoing" over the years. Isn't this procedure medically neccessary? Shouldn't they cover it anyway? HELP?!?!?    — [Anonymous] (posted on October 30, 2000)

October 30, 2000
Look carefully at the insurers on this site read them, even if it not your insurance. The exclusion is a hard point one that I have seen people get approved anyway. But I did not have that kind of luck. I just changed HMO's when I could, picking the only one without the WLS exclusion. I have also noticed recently even though it is medically needed they still denie even with Legal Action...
   — Tamaria W.

October 30, 2000
Hi....I lost my battle on the exclusions and I have double coverage...not to discourage you but to encourage you to fight, fight, fight...then give up and find another way to pay for it like I have....the encouragement is to not let the exclusions get in your way or bring you down(even though you feel like yelling at everyone at the ins co, at our government etc, etc)...find an alternative for paying for your surgery...it's just to important and you I can't wait for society to change for us...good luck! Debora
   — Debora H.