Question:
I need help with an exclusion.

My husband's insurance just came back to my surgeon and said thatthe company had put an exclusion in it's coverage. What should i do first. From what i have read here I should write/call the H/R person and find out Why? The lanuage is as follows "medical or surgical treatment for obesity unless otherwise specifiied in the covered services" My bmi is 44 -isn't this morbidly obese and shouldn't i be covered ?I need help people. The company is really small, do you think this will help my chances? HELP!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!    — L. A. (posted on April 13, 2001)

April 13, 2001
I am the new HR Outreach Director for AMOS. We are currently putting together a packet of information to help folks in your situation (it isn't done just yet). Have you contacted your husband's HR department to find out their procedure to review an exclusion? More than likely you will have to be ready with documentation from your doctor that WLS is medically necessary and write a letter to the HR department requesting the exclusion be removed. You may email me privately and I would be happy to help in any way I can. [email protected]
   — Jilda H.

April 13, 2001
I looked up BC/BS Carefirst and found Lisa Lyons had them for her insurance there in NY and they approved her and she had the surgery. You may want to look up her profile and email her and see if she can let you know what her surgeon/PCP did to get approval. Good Luck!!!
   — Dawn R.

April 14, 2001
The key words I saw in your exclusion were "surgical treatment for obesity . . ." did you notice it said NOTHING about "MORBID obesity"?? Treatment for obesity is different than treatment for morbid obesity -- two different diagnosis. Try this website: obesitylaw.com
   — Cindy H.

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