Question:
Can somebody please read this EXCLUSION?

I have Assurant individual PPO and the exclusion says exactly this' "Treatment of quality of life or lifestyle concerns including but not limited to smoking, obesity, hair loss, sexual function/dysfunction, inadequacy or desire, or cognitive enhancement". --I can't tell you all (I probably don't need to) how much it bothers me that my problem with MO is even is this category. Has anyone been covered with an exclusion like this? I really appreciate any help anyone can offer. Thanks, MB    — michelle barudi (posted on December 5, 2005)

December 5, 2005

   — Catrina

December 5, 2005
I had been using a PPO thru BC/BS of Georgia, my husband's big boss had all the insurance set up to not include pretty much the same thing on your exclusions which is horrible because obviously I'm over weight, and I'm bi-polar with no mental health coverage. I only have it thru Medicare and their being a royal pain about paying their part of the visits. I totally understand how you feel. I am dropping my hubbies insurance as of January 1 since I'm already covered on Medicare, I picked up a supplemental thru Humana which covers most of the things listed here. Sometimes in order to get what we want we have to pay for it ourself privately. PPO's are much better then HMO's much easier to find a doctor in your area that you like also allows you to go outside of your network without being punished by refusing to pay. I'm a disabled LPN, had been a pharmacy tech and a nurse who worked in Nursing Homes who had to chart to get medicare and insurances to pay correctly, very away of major pit falls of alot of insurance plans.
   — Deborah Joyner

December 5, 2005
Coverage for 'morbid obesity' is often covered, whereas 'obesity' is usually not. Ruth
   — [Deactivated Member]

December 5, 2005
"Treatment of quality of life or lifestyle concerns..." Hrm...sounds good to me. What do they say about medically necessary procedures used to treat ongoing ailments? If this is their exclusion for WLS, they've left it WIDE open.
   — RebeccaP

December 5, 2005
can you maintain that you are treating the co morbids?, diabetes, sleep apnea? hypertension? I dont care about being obese, I want be free of diabetes 2, thats why i want a ds. not a rny,that does cure diabestes,like the ds. that the whole point of my appeal.
   — walter A.

December 5, 2005
I have Assurant Health, also an individual policy. I know it's the same plan as your 'exclusion' reads exactly the same as mine! I have been denied twice. I am currently using Gary Viscio to appeal. Please e-mail me directly for more information. Since I am in the appeals process, I don't want to post too much info here as these are open boards. Thanks, Laura M
   — [Deactivated Member]

December 6, 2005
Michelle, Sorry to tell you this but I fought them for over a year and they will not pay. Period! I have been ill for over three years and will one day have to go on disability. They do not care if you are dying they will not pay. In my opinion Assurant formally Fortis is the worse insurance you can get.
   — lorid1020

December 7, 2005
It may not apply if you hae comorbidities such as sleep apnea, high blood pressure, that threaten your life. It only excludes people who are wanting the surgery just for the psychological damage or just for losing weight. If you have a comorbidity it may still be comvered. the best thing to do is call your insurance company or visist their online site.
   — Novashannon

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