Question:
Can you be approved even with an exclusion?

My insurance is BCBS of Texas PPO. They said this surgery is not covered because my employer chose to have an exclusion to WLS. Here is exactly what the exclusion says...any services or supplies provided for reduction of obesity or weight, including surgical procedures, even if the Participant has other health conditions which might be helped by a reduction of obesity or weight...could there be any way around this or is it hopeless??    — Kristi M. (posted on September 12, 2001)

September 13, 2001
I believe that you can pursue your employer for discrimination under the American Disabilities Act. I don't have the website address with me but it's called Obesity law and there's a lawyer Lundstrom that handles obesity cases. I'll get that to you tonight
   — [Anonymous]

September 13, 2001
<font color=purple>I am in a similar boat.. w/ BCBS of Oregon.. only they are my employer too.. I'm working w/ Walter Lindstrom to fight mine.. who knows what will happen. In the meantime I'm also working on trying to get legislation going in Oregon to pass a bill similar to other states (Maryland, Virginia and etc.) Email if I can help at all at</font> <font color=blue>[email protected]</font>
   — Dawn R.

September 13, 2001
Kristi, never give up hope! Your employer was making an obvious and knowledgable discrimination against any overweight person in his company when he made that decision to not include those options. You do have a foothold, but you will have to get a lawyer. It may only take a simple letter from a lawyer, or it could go to a full-blown case depending on your employer. If I were you, I would contact a lawyer who has had experience in discrimination cases and at least try... you won't lose anything if you don't (pun intended!) :) .
   — Sharon H.

September 14, 2001
I had an excluson with my employer I have Cigna HMO and I got approved with a couple of letters. I was told to go to my benefits rep at work and ask them to make an acception to the exclusion which they told me it had to be medically necessary and I needed a DC9 letter from my surgeon which I got. After I gave the benefits rep the letter they sent a letter to Cigna which then came back and denied me for no doctor supervised weight loss attempts. I sent in a second appeal and after 2 and a half months they finally approved me surgery date Nov 15 2001. So don't get discouraged it just takes a little work and patience but it can happen.
   — POOBEAR