Question:
What do you think about this exclusion? The ins. is UMR
plan excludes charges for treatment of obesity,including and which is primarily dieting or exercise for weightloss.the exclusion does not apply for non-surgical treatment of morbidobesity if a treatment plan has been submitted to and approved by UMRprior to initiation of treatment. if you have any info.email me @[email protected],Debra — Debra C. (posted on March 16, 2001)
March 15, 2001
Is that how your exclusion is specifically worded? It was hard to follow.
If I understand it says it exclused treatment for obesity. I guess if that
is the case it may be hard.. I wouldn't give up though.
— Dawn R.
March 16, 2001
Whatever your exclusion says...if it is through your employer that you have
this coverage go to your employer and ask them to override the exclusion.
If you physician words it in such a way that it is life threatening then it
will be hard to refuse. At any rate, your employer is the one that
generally includes exclusions because of the cost to their employees. Try
it and see. Best of luck!
— Sharon R.
March 16, 2001
this is the exact wording
— Debra C.
March 16, 2001
I think what it is saying is that if you are obese they will not pay for
treatment, but if you are morbidly obese they will pay for medication,
weight watchers etc.. things like that, but NOT surgical treatment. Ask
them how they can justify offering to pay for a treatment that is proven
not to work for morbid obesity. Also, it doesn't specifically say WHAT
surgical treatment they won't pay for. Maybe they won't pay for your jaw to
be wired shut but they will pay for the "gold standard" in
treatment for morbid obesity. If it is through your employer call them and
ask them will they pay for RNY procedure. Fight it!!!!!
— K T.
March 17, 2001
thanks for the replies,my husband said he's going straight to human
resources to figure this out,although i haven't recieved a denial letter
yet.i do have a letter of medical neccessity through my DR. and DR.champion
for hypertension,GERD,depression,and back problems.maybe i still have
hope.thanks again,Debra
— Debra C.
March 27, 2001
I got a approval letter,as did Dr.Champion also.well when they called to
check the benefits,they said i shouldn't have recieved a letter of
approval.now they are saying i have to go thru my husband's employer to
override the exclusion.this pisses me off.for a week i thought i was
approved.this is really depressing me,but i'm going to fight for this.Debra
— Debra C.
Click Here to Return