Question:
Do you see this as a solid exclusion?

Can any help me? I just found out today that my employers policy states the following is not covered: "Non-surgical and surgical treatment of obesity including severe obesity and morbid obesity even with a BMI greater then 35." Is this iron clad?    — Mary S. (posted on January 12, 2004)

January 12, 2004
Mary, It sounds an awful lot like the exclusion my insurance coverages had. However, the best bet is to contact one of the two attornies that I know of who deal in helping patients with insurance issues. Here are the links: www.obesitylaw.com www.obesitylawyer.com I'd email them asap if you're willing to fight. Or, you could consider self-paying. That's what I ended up doing after hearing from Walter Lindstrom that it was a hopeless cause with my insurance coverage. Going self-pay was the best thing I've ever done for myself! If you'd like to know more about my story, you can see it at http://www.duodenalswitch.com/Patients/Dina/dina.html - and you can find out more about my surgeon - Dr. Aniceto Baltasar at www.bodybybaltasar.com Hope that helps a little! Blessings, dina
   — Dina McBride

January 12, 2004
If you have any major co-morbid conditions such as Diabetes, Gerd or Hypertension, they MIGHT consider it. You could send them a Letter of Medical Necessity and just see. Is your BMI over 40? and who is your insurance carrier?
   — issymudd

January 13, 2004
Hello Mary :) Well, the exclusion sounds pretty iron clad to me. In cases like this, medical necessity doesn't even matter unfortunately (I've been there). The best advice that I can give you is to contact your employer. Go to your hr department & tell them the situation. Tell them all about your poor health & why you need this surgery. Employers do have the power to "overturn" an exclusion or make "exceptions". I will be keeping my fingers crossed for you! I wish you the best - let me know how things turn out. ~Amanda :)
   — amandalianne

January 13, 2004
Unfortunately, I had the same exclusion and ended up in Mexico for my surgery which I would do again in a heartbeat! See my profile for more details! Good luck to you though... Shawna 445/269/165 - Dr. Aguirre, May 2, 2003
   — SMG I.

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