Question:
Is there any way around an exclusion like this?
My husband is a contractor for our local cable company and since this position doesn't come with insurance, he is looking into getting covered through his supervisor's policy. Tonight, I went online to see if I could find something since I had never heard of it before (It's Continental General) and this is what it said under the exclusions and limitations category: NO benefits will be paid for charges: For Treatment of obesity, morbid obesity or for weight reduction purposes---is there any way at all around something like this?? Thanks, Jeralyn — Jeralyn Merideth (posted on February 28, 2002)
February 28, 2002
Hello. From what I understand,when you have an employer exclusion for WLS,
you generally have to fight and appeal with a lawyer, and these cases are
very difficult to win. I wish you much luck though.
— rebeccamayhew
February 28, 2002
I had a written exclusion in my policy too (self-insured by the state) and
they didn't care how medically necessary it was, they were not paying for
it. I do think I could have gotten a lawyer and fought them and maybe even
won but we decided it would cost us more money and more time to do that so
we got a bank loan and paid for it ourselves. (My husband and I). The
hospital, anesthesiologist, and my surgeon all gave me a discount (I guess
because they knew they were getting their money up front and wouldn't have
to be waiting on an insurance company to pay them). I have two friends who
have gotten their surgery paid for by Voc. Rehab., you might check into
that. Whatever you decide to do GOOD LUCK!
— esthjb
March 1, 2002
My insurance company has an exclusion as well - same basic wording as your
own. I am on my 3rd appeal but due to some health problems I am having and
will continue to grow worse if I don't move on, the health problems could
put me in a place where a major surgery could be an even bigger risk if I
wait so I've opted to get a loan and cover it as a self-pay for now. I
felt that we make loans for things like our vehicles, homes and other
luxuries - why shouldn't I be able to seek a loan to save my life? My
husband backed me 100% and that's what we did. I am in the process though
of hiring an attorney. I was going to use the one through Walter L.
w/ObesityLaw.com but I opted not to for a few reasons. I got his paperwork
and it seems like it's gone somewhat routine and very impersonal. I have
heard of 4 people who went through him and paid $750.00 or more to just be
told it was an 'air tight' exclusion. I am hiring an attorney within my
state and I've been told he's the very best. I am fighting this for a few
reasons - for the people who are like me who are not able to secure a loan,
I think it's extremely crappy that insurance have the ability to pick &
choose medical treatment that patients need. I am also doing it because I
need backup and support if there are any complications to my surgery
(scheduled next month) and them denying payment to help with any problems
associated with this surgery or what they may find once the doctors examine
me. For the doctor and his associate, the hospital and the
anesthesiologist with a normal 2-day stay for the laproscopic RNY, I am
expecting to pay approximately $25,000.00. If it goes into a 5-day stay or
a 10-day stay, I could be in serious, serious financial trouble. It's not
right, you know what I mean?
I'll let you know how the exclusion fight goes - I'll check back often.
Sorry for the anonymously posted message but I want to hit the insurance
company on a 'sneak attack'. :) I know they follow these pages as well.
Good luck in your quest!! Let's keep on fighting so the people after us
may have some success.
— [Anonymous]
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