Question:
I have a written exclusion in my policy, what can I do?

   — TONIGIRL (posted on June 18, 2004)

June 17, 2004
I too had a written exclusion in my policy. I fought... fought... and fought some more, only to be denied and let down each time. I ended up going to Dr. Aguirre in Ensenada Mexico and am thrilled that I did. My sister had her surgery in Virginia 7 months after me and she realized that I had far better care in Mexico than she did in one of the top rated hospitals in VA. Go figure. I would do it again in a heartbeat. Check out his forum on here. Good luck to you!!!
   — SMG I.

June 18, 2004
Well, you could fight. I would recommend contacting one of the attorneys that specializes in fighting this sort of thing. www.obesitylawyer.com or www.obesitylaw.com - they can probably tell you up front whether or not it's worth investing any $$ into a fight based on your insurers track record. Or, you can self pay. Some self-pay in the US, others of us go out of country for our WLS. I had my open BPD/DS with Dr. Aniceto Baltasar in Alcoy, Spain - *almost* 2 years ago. I had wonderful care, an excellent recovery, and have lost 205 lbs, nearly all of my comorbidities, and have regained my life. For a lot of us, the final word that the written exclusion is solid is a new starting point. Personally, I'm so thankful that my insurance DIDN'T pay - I probably would have never dug deeper and learned about the DS option, or met my wonderful, caring, kindhearted surgeon. Blessings, dina
   — Dina McBride

June 20, 2004
Jerrie, unfortunately, not much (but as suggested by one reply let a lawyer look at it). If you have access to your benefits department you can request a confidential meeting. My company actually got rid of the insurers who denied me and now we have a different plan w/o the exclusion. Any medical discussion with your benefits department should have a signed waiver, which states your privacy privileges, and cannot be discussed outside of benefits department.
   — Anna M.

June 22, 2004
Contact your county vocational rehabilitation. With documentation of previous physician directed weight loss 6 month program)you could be approved. I am a teacher with BCBS of MS and we have an exclusion policy. Just went through VR and had my surgery on April 1. Only out of pocket cost to me so far has been $900. IF you need help, email me. I will be glad to help you.
   — Kitsy I.

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