Question:
Has anyone been successful in obtaining approval despite written exclusions for WLS?

My other daughter is seeking approval for WLS through United Health Care...her husband's insurance. Her copy of stated health care benefits is from 2000 and contains NO exclusions for WLS. When she inquired about WLS this week, she was told that this provider now excludes "any and all surgical procedures related to the treatment of weight loss" and the provider is mailing her a copy of their revised policy. Her husband is changing employment in 2 weeks and will then have federal Blue Cross/Blue Shield. She was planning to COBRA the insurance from United so that she could have the surgery right away, and is afraid that BC/BS will have her wait for several months because they will consider her morbid obesity to be a "pre-existing condition". Has anyone had experience with either of these providers? Will it be worth the time and effort to appeal for approval with United since they have an existing written exclusion? Has anyone obtained approval via federal BC/BS? Thank you for your help.    — Diana T. (posted on March 8, 2001)

March 8, 2001
If her husband is changing jobs, many employer provided insurance policies will 'accept you as you are' without pre-existing conditions if you have had insurance within the last 30 days. What her husband should check out is when his insurance become effective at the new company, since many times there is a 30 day waiting period, and if this statement holds true. He also should also find out how long his insurance is good at the old company (to the end of the month?). I work as a consultant and have never had a problem with the insurance having pre-existing conditions, and I use to switch almost every year. My current company is blue cross of minnesota, which has this provision. The last couple years we have stayed with my husband's insurance, but I double checked this clause since there is a threat of a strike at my husband's company (and he would be laid off). I was told I can be covered, without pre-existing, as long as I was insured within the previous 30 days. I am not even thinking of myself and the surgery, we have an autistic son who requires ot & speech therapy. Penny
   — Penny J.

March 8, 2001
It is definitely an employer thing. Most insurance companies provide an array of policies and they can vary from employer to employer. The employer usually bases their choice on cost. My policy had a written exclusion; however, when I appealed to my employer they were more than happy to help and they have decided to approve going outside of the contract to pay for it! I do believe that my doctor's wording of the significance of this surgery on my overall health was the deciding factor.
   — Sharon R.