Question:
is there a loophole in this exclusion?

"Benefits will not be provided for weight reduction programs or treatment for obesity including any surgery for morbid obesity" Is there a such term as "super morbid obesity"? My bmi is 44.8. Can you see something here I can use against them?    — stephanie L. (posted on July 17, 2001)

July 17, 2001
I wouldn't exactly say there was a loophole in your exclusion. Is there a loop hole in the plan? What is your states Medical necessity law. What does your plan say about medical necessity? Do you have some comorbid conditions, sleep apnea, asthma, back pain, incontinence, type11 diabetes, depression..... Can you show them that it would be cheaper for them to cover the surgery than to cover your medical expenses present and future- that may sway them. I'll bet there is a provision somewhere in your plan that says they can go outside the plan if it is cost effective. Look for that.
   — K T.

July 17, 2001
Super morbid obesity is a BMI greater than 50. Your best bet is to shoot for the co-morbidies and prove it medically necessary.
   — Lynda T.

July 22, 2001
Morbid obesity is considered a disability under the American Disabilities Act. It is discrimination and against the law for your insurance company/employer to not help you. Talk to an attorney and fight -- you will win-- need help? email me!
   — barbara H.

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