Question:
Does any one have any advice on getting around an exclusion?
I've wriiten an appeal letter to employer. they will meet w/me on 3/30. Any advice from any of you who have been denied based on exlusion "weight loss/obesity surgey" not covered. I want to go in w/pleny amunition( information) All advice accepted. ( and prayers too) — Cindee A. (posted on March 28, 2001)
March 28, 2001
You can always fight it on your own. That is what I did...and won!! (I'm
3 weeks post op) Go to my page and check out my appeal letter...hope it
helps.
http://www.geocities.com/Niecey31_Oh/TheQuest
— Deniece H.
March 28, 2001
Approaching your employer is the best bet considering they are the ones
that implemented the policy with the exclusion. They probably did that for
cost effectiveness; however, if your doctor will word his recommendation in
such a way to reflect a life or death condition (which this is ultimately).
You might also want to bring up ADA (American Disability Act) issues.
Morbid obesity is a covered condition under ADA and employers should take
this into consideration when making these type of decisions. Good luck.
— Sharon R.
March 28, 2001
I am the new HR Outreach Director here at AMOS. It is a new position and I
am just getting it up and running. I am here to help you deal with your HR
department and will eventually be able to send out a packet of helpful
information. Please email me and let me know if I can be of any help now
and let me know how your 3/30 meeting goes. [email protected]
— Jilda H.
March 29, 2001
Your best ammunition is to document proof that this surgery is necessary.
Print everyone's WLS story on this web-site and put it in a huge binder and
present that as proof that this surgery is what is necessary. Print any
article from respected surgeons and doctors that state that being morbidly
obese is a disease and dieting alone will never solve the problem. Print
statistics that show the % of deaths that occur in the morbidly obese. I
like Leanne's answer about them excluding "obesity surgery" not
"morbidly obese surgery". Use that to your advantage, that the
company was trying to weed out the people that don't really need this
surgery, but that morbidly obese people need it to live. The more
information you have, the more they will be impressed and maybe bedazzled
by your committment to this. I printed an message from one of our AMOS
friends a couple nights ago that mention the state of Virginia insurance
division is making it mandatory that any group health plan cannot exclude
morbid obesity surgery. I don't have that with me right now, but look
through the past few days and you will see it and print that. Tell them
you will take that to your state division of insurance and convince them to
implement the same practice. If one state is doing it, you know the rest
will eventually. Good luck and let us all know how the meeting goes.
— Dawn R.
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