Question:
does this exclusion mean i can have surgery????

exclusion states for bc/bs healthselect.... weight redurction programs sevices or supplies even if the participant has medical conditions that might be helped by weight loss or even if prescribed by a physician.....    — SHERRY M. (posted on July 23, 2002)

July 23, 2002
The way I interpet it, it sounds like they have covered their bases so you can't get approved. They pretty much said even if it was medically necessary you won't get approved. That sucks! It just galls me that insurance companies have this much control! They would rather pay for all the meds and complications. Makes no sense!
   — Kris T.

July 23, 2002
If it's listed under EXLUSIONS, it means that these services ARE NOT covered, they are specifically EXCLUDED from your plan. I see it as saying that it will NOT cover weight reduction programs/supplies even if medically necessary or even if your doctor says you would benefit from WLS/Program. Is there anything listed under this exclusion?
   — Rosario T.

July 23, 2002
I do not believe anything is set in stone! Try to get approval..if they deny ask why, then ask for their appeal process and appeal, if denied again, appeal again and again, I would keep going until they either approved me or put a restraining order against me! Also, what state are you in, does your state have a law that this surgery must be covered? The Ins. Co will try to get away with not covering it if you do not know what is going on. Go to the internet, find your states government page, look for the attorney generals office and the state Insurance commission, they might be able to help you, don't get cought up trying to figure out who in those office could help...just call them asn tell your story, they will direct you. Visit your states Vocational rehab website, call them , they might be able to pay for surgery. Check to see if your company is self-funded..that means they can override the exclusion in the Ins. policy...you have so many avenues to try..DO NOT GIVE UP! do not give up until you have tried everything, and then..ask for more help! I think some people give up way to soon and miss out on this great opportunity!
   — Patricia R.

July 23, 2002
I have to agree with Patricia, nothing is carved in stone. My insurance excusion said that any and all weight loss surgical procedures were not covered.. then at the end of that sentence it said unless you are 100lbs or more over weight. So they didn't want to cover it, but after lots of sqeeking in their ears, they put some greese on just to shut me up. Good luck.
   — MnShadows

July 23, 2002
I had an exclusion in my insurance that stated surgical procedures were not covered for weightloss and mantainment of weightloss, and with the right dr's fighting i was approved, a lot has to do with you follow up and your persenstance. Most employer's choose insurance plans and then remove benifits of that plan to make it cheaper for employee's and them selves of course. FIGHT FIGHT FIGHT and document document document , everything you can. And find a sugerical staff that doesn't take no for an answer. And have a extreamly well medical nescisity letter from you primary care dr stating 3 words medically supervised, and continious attemts .
   — Dawn W.

July 23, 2002
My advice is "A squeeky wheel always get's greased". I too have BCBS and my policy excluded it "unless medically necessary" They told me flat it was excluded even AFTER I faxed my policy and circle "MEDICALLY NECESSARY" Persist, persist, persist...I worked for me. I called very day and finally got approved. Good luck! Lora Todd
   — Lora T.

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