Question:
Exclusions, how do you get around them?

If there is an exclusion in your policy, can you get around it? I work for a hospital with First Choice as their Administrator. Bariatric Surgery is excluded.    — anuthrtime (posted on January 23, 2006)

January 23, 2006
I HAD AN EXCLUSION ON BOTH OF MY INS. FROM MY EMPLOYER AND MY SPOUSE. THEY TOLD ME TO CHECK WITH HUMAN RES. COME TO FIND OUT THE EMPLOYER USUALLY HAS THAT IN THERE. TRY TO FIND OUT IF THEY COULD CHANGE IT. MINE WAS NO HELP SO WE CHANGED INS. THE FOLLOWING YEAR. IT IS VERY FRUSTRATING. DON'T GIVE UP THERE IS ALWAYS SOMETHING YOU CAN DO IF YOU FIGHT! GOOD LUCK!
   — WARTMELANOMA

January 23, 2006
My employer is Verizon, and they exclude the ds and out of network doctors only for wls. My UNION has a embeded representive who deals for Verizon directly with Aetna, to oversee appeals, medical neccessity, dictates I cant have a rny,or band, and nine bariactric surgeons innetwork have refered me to DR G for surgery, My union has a interest,and so does my employer of getting what was bargained and paid for from Aetna.
   — walter A.

January 24, 2006
Sometimes you can get an exclusion from the exclusion if you have several comorbidites (sleep apnea, high blood pressure, diabetes). You have to talk to your doctor and get him to write a letter, and go to specialists for your comorbidites and get letters, etc. They have to tell the insurance company that t is medically necessary.
   — Novashannon

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