Question:
I got denied with the first letter due to an exclusion on the policy.

The exclusion stated that treatment of any kind for weight reduction, weight control or obesity is excluded except necessary gastric shunt operations. Well gastric shunt is gastric bypass. So does this mean I just have to prove that it is "necessary"? Did anyone else have this exclusion and fight and win? If so any tips?    — ronnieL (posted on October 20, 2000)

October 20, 2000
I'm not sure what they mean by "shunt" but if you analysis of the word is correct then yes, I believe that means you have to prove medical necessity. My insurance company's policy was stated in the same way, although they didn't deny me. Things you can do: get a sleep study, sleep apanea is considered a co-morbidity , if you have went to any doctor because of your weight get a letter from the doctor stating that, if you have a family physician you went to as a child or teenager and you were also over weight then, have the doctor write a letter stating your weight problem has been ongoing and for how long. You can also use family history of medical problems (again a family physician who knows you and your families histories) If that doesn't work then get a lawyer, Walter Lindstrom is the lawyer most recommended and you can find out his information on this site. Just keep trying and good luck!! Oh, by the way, if you are in Indiana and the insurance denied you, there is a law now that states insurance companies have to cover WLS.
   — christine L.