Question:
My insurance company has changed what they originally told me now say wls is excluded

I was originally told that wsl was on a special request basis. Now I am being told it is specifically excluded. My PCP has never referred someone for wls before and I am afraid he won't know what to do now. I have contacted my human resources department and have started inquiries there, including asking for the specific exclusion clausein writing. What do i do now. I am very frustrated.    — cheryl R. (posted on August 25, 2000)

August 26, 2000
I know you feel in the depths of despair. What you did was correct. You need to know the exact wording of the exclusion. I am quoting from something another member here sent me from Walter Lindstrom where he says "there are differences between weight control, obesity and morbid obesity. and these exclusions do not generally ever address co-morbidities. Some exclusions address ""procedures"" such as gastric stapling, intestinal bypass, etc. and the company's use or archaic language may be of assistance in defeating these as well. Other exclusions aren't exclusions at all but rather a purported failure to establish ""medical necessity"" in accordance with Medical Policy Criteria that is separate from the policy." I have another post that says MAKE THEM PROVE IT. Send a certified letter to them asking them to send you the exact part that says surgery is excluded. Why and under what conditions. This is because everyone that is involved often says they didn't get things. It is possible that weight loss surgery is excluded ""Except for"" certain cases and usually, the certain cases are "morbid obesity" and obesity with life-threatening complications. I have more information and posts on this but this is a way to start. Best of luck. Hugs.
   — JennyLynn A.