Question:
My best friend wants to have Lap RNY surgery, but her insurance excludes surgery

for obesity or morbid obesity. She tried to get a different health insurance with Blue Cross/Blue Shield but was denied because of being overweight. What should she do next? Her regular doctor has recommended the surgery due to her health, but her insurance denied it due to the exclusion. Is there anything else she can do? Obviously her weight is a health risk since BC/BS won't insure her.    — [Anonymous] (posted on January 13, 2002)

January 13, 2002
You didn't say who her insurance is with now. But anyway, I am still in the process of gettng mine approved but here is what I did so far. My insurance is with BC/BS of Louisiana. The policy has a written exclusion in the policy that excludes WLS for morbid obesity regardless of medical necessity. I wrote a LONG letter to my husband HR director at his employer. I sent the letter on Monday, January 7 and received a response back from them on Saturday, Jan 12th. I didn't expect a response actually and was quite pleased I did. Anyway, there response was basically this, presently our program doesn't cover the procedure you are seeking without a letter from your doctor noting medical necessity and your condition resulting in a threat to your health. Now I take that to mean as long as my doctor and myself can show its medically necessary it will at least be considered and possibly approved! Totally goes against what the exclusion says.....but this came from the horses mouth per say! I am running with it and NOT giving up until I can get it approved. SO, whomever your friend has insurance with now, she needs to contact the HR person and start there, if its threw an employer. If you would like a copy of the letter I wrote you can search the message board or email me and I will be happy to forward it. Good Luck!
   — lesleeloo

January 19, 2002
Well i actually have no insurance at all and i was recommended to my states Vocational Rehabilitation Depatment. I know every state is different but i live in oklahoma and i had no problem at all getting approved for surgery. the only problem we have is finding a surgeon that excepts the rate of pay from the state. All i had to prove was that i had trouble getting or keeping a job due to my disability (morbid obesity) or that it made working hard on a day to day bases. i really hope this helps you and good luck, it's a different route but it's worth it! :)
   — LaKeAffy