Insurance exclusions

I have started the process only to find out now that my insurance has an exclusion in it. It will not pay for weight related issues (surgery or medication). I have several comorbidities and already have seen a surgeon who feels I definately can benefit from having the gastric bypass. What, if anything, can be done about the exclusion in my insurance?

I pray that you can find another solution to have WLS as I truly believe it can save lives and I am counting on it to do just that for me :) With that said, I will tell you what I have heard over and over again. If you have an exclusion that you better find another way to pay for it, because they are not going to. There are excellent financing options etc. so not is all hopeless.  Maybe someone here has had success battling an exclusion and can provide some solutions. I hate to disappoint you, but there is still hope!

Unfortunately if your plan excludes WL surgery you are SOL.  The insurance company administers the plan for your employer, they have to follow what the employer wants to cover, if the policy is self funded, which most are.

You may want to check with your HR department, and see if they can request a rider.  I have been told so many different things that it is so hard not to try every suggestion that is out there.  Currently I am at the point where the insurance cordinator has told us that the employer can request a rider on the policy, However that means that the premium will go up.

 

Good luuck to you!

Sometimes an exclusion doesn't count if you can prove MEDICAL NECESSITY. This is a fun little word that my mother knows all about. She has United Health Care and the explicitly state on her policy that it is excluded. Well she was approved last week.