Question:
Written exclusion ... but isn't there a way around THIS one?

My exclusion says, "For the treatment of obesity or any complications arising therefrom, including but not limited to Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw, office visits, laboratory services, prescription drugs, medical weight reduction programs, nutrients, and diet counciling (except as otherwise specified in the contract) and health services of a similar nature." So, nothing was mentioned about "Severe/ Morbid obesity" or "Medically neccassary." I guess my question is, would that be my way around this??? I appreciate ANY help!!! email: [email protected]    — Shon F. (posted on January 2, 2002)

January 2, 2002
Lashonda,it sounds to me like they have pretty much covered everything in your writen exclusion policy. Bummer... I had a written exclusion in my policy too, they didn't care HOW medically necessary it was. I suppose I could have gotten a lawyer and tried to fight it but I didn't want to spend the money on an attorney, court costs, etc. So my husband and I took out a loan and I was a self pay patient. My surgery was Dec. 11th (open SRVG)and I have lost 25 lbs. so far; I feel fine. You have nothing to lose in trying to get approval, go for it! And if they deny you I have seen plenty of messages posted on the website from people who have managed to get their denial overturned. You never know!! Good luck to you!
   — esthjb

January 2, 2002
LaShonda - I have the same exclusion under my Paramount policy and am fighting it with the help of a local attorney. The consultation was free, and since I am doing the legwork myself the fees will be highly reduced. I understand that some people have had good experiences with Walter Lindstrom out in California who specializes in obesity law. Why don't you inquire with your local Amercian Bar Association and see if they can't refer you to someone? Where there's a will there's a way! I won't stop until Paramount either pays for my surgery or gets dragged through court. I'm doing this for me but it may eventually help others, and for this I am glad.
   — Diane P.