Question:
Could it be excluded from the exclusions?

I know I'm only dreaming here, BUT under Exclusions listed in my handbook it lists #1 "Medical treatments that are not neccessary." #2 "Surrogate parenting, or elective abortion." There are many more exclusions that just list the things not covered, but for WLS...they add "are excluded," at the end... as they did on "Optometric therapy." I'm not sure what that is, but the handbook lists a lot of things that are not covered... #3 "fitting for eyeglasses, or contacts." Stuff like that, then they start a new sentence (under the same #) and say "Optometric therapy is excluded." Since this is listed under exclusions, could Optometric therapy, or WLS be excluded from the exclusion? Could this possibly be their way of throwing people off, and make them think that it is not covered....hoping when they see "are excluded" they just disappear? Why didn't the 1st exclusion say "Medical treatment not neccessary is excluded?" I don't understand why only 2 or 3 things have "are excluded" added to the end. They could have just as easily wrote "Services for eye glass fittings, contacts, hearing aids, and optometric therapy are excluded." Why did they list all of those exlusions, then start another sentence and say "are excluded?" I hope I didn't confuse everyone...but I'm confused myself. Any input would be helpful. Thanks...    — Shelly T. (posted on August 28, 2000)

August 27, 2000
Shelley, I really don't know the answer to your question, but in my insurance plan document the ONLY place I found reference to WLS was under exclusions. It said something like: The following are specifically excluded....... and then said "Services, drugs and supplies for weight control or treatment of obesity, except surgery for documented morbid obesity." It was hard to find that reference; well hidden, I thought. My surgery was approved after one letter.
   — Kathy W.

August 27, 2000
Dear Shelly, Your post is unclear. Because when referring to exclusions the EXACT language is so important what is the sentence(s) that has to do with any of the following: Weight loss, obesity, WLS, morbid obesity, or anything else that relates to weight loss. Please post again with it exactly as it appears in the insurance contract. That may help us better help you.
   — JennyLynn A.

August 28, 2000
My insurance excluded weight loss surgery and anything diet related. However, it was covered because it was "medically necessary." So, it is worth a try.
   — Cindy H.

Click Here to Return