Question:
Anyone have a BC Exclusion for
My policy has a written exclusion for "weight control" In the policy and Im having a hard time finding a lawyer and I refuse to pay MR Lindstrom 350 up front for him to tell me he cant help me without first knowing if he can. Any advice would be helpful, and I cannot pay for this out of pocket. — Dina L. (posted on December 3, 2001)
December 3, 2001
I have BCBS of South Carolina for State Employees. My policy has a
exclusion--BUT it will pay if the surgery is determined to be medically
necessary for Morbid Obesity. I was approved in less than a week after my
surgeon's office sent in the letter.
— [Anonymous]
December 3, 2001
If you plan states "treatment and/or care are excluded" you
probably will not win an appeal on the issue. If the plan states the
exclusion, but then goes on to address medical necessity you have a good
chance if you meet the criteria.
(ie, bmi +40, comorbidities for less than 40, 1 year of physcian supervised
weight loss attempt, etc).
— [Anonymous]
December 3, 2001
HI,
My policy with BC/BS also has a written exclusion for weight loss and also
for surgery, so they deny it totally. However, I was told it is because of
the employer wanting to keep that exclusion in the policy. Otherwise BC/BS
normally does cover WLS. My next fight will be with my husband employer,
although I am not sure exactly how to pursue that.
— lesleeloo
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