Question:
Exclusion does not specifically address surgery or morbid obesity

My husband's health insurance states:"No payment will be made under this Plan for expenses incurred by you or your dependent: for charges for the treatment of obesity, weight reduction or dietetic control". The bariatric center I consulted called our insurance and were first told that the procedure was covered benefit. Two weeks later when they checked again, were told it was not and would not be covered, don't bother us again and everything came to a screetching hault. Since the center was told there was an exclusion, I was told not to bother trying to appeal. Any body come across something like this? Any advise will be greatly appreciated. Thanks!!!    — Mari T. (posted on March 23, 2002)

March 22, 2002
Go and take a look at this website, i'm pretty sure he'd be able to help you. You can even give him a call. http://www.obesitylaw.com Obesity Law & Advocacy Center 7710 Hazard Center Drive, Suite E, PMB No. 443 San Diego, CA 92108 Our telephone number of (619) 656-5251 and fax number of (619) 656-5254 remain unchanged. The email address remains [email protected].
   — Laydie K.

March 23, 2002
ALWAYS APPEAL!!!!! As for your 'exculsion' you do have a "door" to appeal! just the fact for what it doesnt SAY! for starters' Morbid Obesity is NOT the same as 'obesity' I have BCBS they dont pay for "obesity' and 'diet' but they 'pay' for surgery and "morbid obesity'... FIGHT!
   — star .

March 27, 2002
Thank you for your answers and encouragement!!! I have decided that I will proceed with this and not let an "exclusion" or the fact that the bariatric center said not to bother appealing stop me!!! My terrific primary care physician has agreed to help me with my appeal and is writing a letter to help me. Thank you all again!! Continued good health!!!
   — Mari T.