Question:
Has anyone heard of laws for ins EXCLUDING this surgery and how to fight them?

My ins specifically EXCLUDES Gastric bypass.. 1st appeal was DENIED they wont pay. Are there any LAWS that regulat this since its medically necessary??    — Dina L. (posted on November 14, 2001)

November 14, 2001
BC/BS said they would cut off my leg before covering WLS. I am trying to get a law passed in MO now to keep the insurance co. from excluding this surgery and other treatments for morbid obesity. Good luck.
   — richter454

November 14, 2001
walmart has self pay ins. they have that exclusion called the st ins commissioner and he said that he has no jurisdiction on co with self pay ins so i have decided to pay myself it will probably take me teares to pay of but it will be worth it good luck also hiring a lawyer will do no good sorry sandy
   — sandy E.

November 14, 2001
Dina... I am still waiting to see if BCBS Carefirst in MD will cover me (I live in DE but company has MD insurance) as they have the exclusion. I did receive an email from one in this group though that said MD passed a law Oct. 1 2001 that demands inclusion as a covered procedure. So you might check out this law and see if you can do anything with it in your state. As an explanation too... self pay companies most times are ERISA plans and they can set their own standards, and do not have to follow many of the norms of other plans. I think its why many companies are changing healthcare to go to self pay. Good luck.
   — AJC750