Question:
Gotten Approval Even though you had a Exclusion Clause.
I Got my denial last week, and am preparing the appeal letter, along with some research ive done on the cost, and health risk of obesity. Im gonna try to educate my insurance company on this illness. I Am still curious to find out if anyone here, has ever gotten approval even though they had a exclusion clause in their policy. And done the approval themselves. I Am very aggressive when it comes to this, and was helped by another member here, on how to write my appeal letter *Smiles*(thanks Stacy). But I really would like to know if anyone has been where I Am..Gotten Denied because of the clause, did a appeal themselves, and got approved??? So if anyone could tell me, Id love to know, and any addition Information would be so Appreciated *smiles*..(The clause is what i consider too Simply It states, it will not pay for services related to overweight management or obesity) tell me what you think? Thanks!!! — Ann A. (posted on March 3, 2000)
March 3, 2000
The word you are looking for is "ambigous". This is what that
clause is in your insurance exclusions. The best thing to do is go to the
web site dranonymous.com. and download his handbook on insurance companies.
It will cost you $7.95, but it is well worth the cost. It will print out
about 40 pages. It opened my eyes!!Very helpful in dealing with the
insurance company and using terminology and langage they throw at us! Keep
fighting and good luck. Got my approvel just yesterday (after they denied
me the first time) My insurance is United Healthcare of Florida. Hang in
there and fight!
— Beverly A. K.
January 29, 2001
I would love to know the answer to this too. Specifically I have Regence
HMO Oregon through BCBS of Oregon. Obesity treatment is an exclusion on my
policy. I know I will get a denial. I would love help writting such a
letter.. would you be willing to help me or get me in touch with who helped
you? Let me know. Your help would be greatly appreciated.
Dawn
— Dawn R.
January 29, 2001
To the person who posted the insurance website - can you give a specific
address? I tried that and I came up with nothing.
— [Anonymous]
January 29, 2001
I posted this post about a year ago, when I had John Alden who had a
exclusion clause. We ended up appealing three times, and got turned down,
they stood by that exclusion and would not budge, I even contacted a
attorney, and found that I would probably end up paying the same for
fighting as I had if I would self pay. My husband in the mean time seen
what it had done to me, and Changed jobs to ensure me a fighting chance, We
got Cigna PPO, and my first attempt was again denied, im sure all of you
that have been through this fight can imagine how I felt. Well then I
fought harder, I went to every doctor I had, asked to write letters, wrote
a letter myself, my husband did, my family did, and I educated myself about
the surgery, Made copies of everything I could, and sent another letter of
appeal, I am happy to say that I was finally approved on Dec 29,2000, and
am having surgery in Clevland on May 9,2001. I realize that many can not do
what my husband did. And I also realize that alot of insurance companies
are coming around to see that most of us need this surgery for medical
reasons, not to just be"thin". I hope and pray this will be a
option for anyone that is in need, I would make sure you contact your
local, state and federal govt parties, get the word out, educate people,
and keep FIGHTING, no matter what. I hope this helps a little. I Am praying
for all those who are fighting so hard for this. Good Luck , and if I can
be of any help. please feel free to contact me...
— Ann A.
September 14, 2001
I too have been denied 3 times by my ins. john alden. the clause simply
states will not cover obesity or weight loss. i have tons of co morbid
symptoms but they just ignore them. if you get any help please pass it on
to me. danica
[email protected]
— DANICA M.
May 31, 2003
I was also denied by Unitedhealth Care due to an exclusion policy. At this
moment, I'm agree with the county commissioners for allowing this exclusion
in our insurance policy. I wonder if the policy writers truly understand
the serverity of obesity. If anyone has any suggestions on anything I can
do besides quit my job, please let me know. Thank you. Rae Lewis- BMI
44.3
— Rae L.
November 29, 2004
I am in the process as you are, I got preapproval on Nov.3 and on Nov, 24
got a denial letter. Insurance companny claims my husbands employer
upgraded the policy between those two dates given which excludes WLS. Now
appealingprocess will start with me, will keep you posted.
— Kris N.
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