Question:
What can be done if there is an exclusion to the surgery in insur policy?

I work for the largest health care system in this city and wls is not covered by our insurance policy in any fashion, no matter how medically necessary. Is there anything that can be done? I don't have a lot of money to hire a lawyer but really need this surgery.Thanks    — karen A. (posted on July 13, 2003)

July 13, 2003
Hi, Karen, the only thing I can suggest you do is try to have your pcp write a letter to your insurance company explaining what all you have tried to lose weight and what health probs you have, etc., or have your pcp call them personally sometimes that helps, that is what my mom's pcp had to do for her. And, the only other thing I can suggest you do is see if you can switch ins. company's thru work, or pay out of pocket, some hospitals do take payments, or so much up front then more later after surgery. And, they have the lap band in Mexico , for $10,000. Just look into diff things in your state. Good Luck to You!
   — Melodee S.

July 14, 2003
Hi Karen :) I had an exclusion in my policy as well. I unfortunately never beat it, but here are a few things to check out. Sometimes (like in my case) your employer will have the ability to make an "exception". Check with your HR department. Otherwise, what are the exact words of your exclusion? Sometimes there are loop holes. There is a good support group with yahoo (ossg-insurancehelp) that you could look into for more suggestions. Just don't give up hope! I wish you all the best :)
   — amandalianne

July 18, 2003
Dear Karen, My Husband works for Wal-Mart. They have an airtight exclusion. After I tried to get the denial over turned, I e-mailed Walter Lindstrom ( An Obesity Lawyer from Ca.) He will tell you up front for FREE if you have a chance of fighting it or not. Good Luck!
   — Susan W.

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