Question:
Solid exclusion or not?
Under exclusions, my policy states, "Weight reduction treatment, surgery or drugs (including appetite supressants). Would this be a solid exclusion? — Mary S. (posted on February 27, 2004)
February 26, 2004
It reads as though they won't cover ANY weight reduction methods. But I
would call your provider and ask just to be positive they can tell you for
sure. Good luck.
— Vitabella
February 26, 2004
Mine basically said the same thing, but they wound up paying for the
surgery anyway. It's worth having a doctor send in a letter of medical
necessity in just to see. Especially if you have medical conditions that
are caused by or aggrivated by morbid obesity. Just go into it knowing
there is a fairly big chance you will be turned down, I know it's hard not
to get your hopes up. I wish you the best of luck.
— issymudd
February 27, 2004
You're not having weight reduction surgery, your having surgery to reduce
your obese or morbidly obese condition, AND to releive or alleviate the
symptoms of co-morbid condition. So no, my opinion, nice try, no
exclusion. Check out your State law, but these exclusions need to be very
specific and here in New York and some other states, exclusions do not
apply if the surgery is medically necessary.
In other words. Fight 'em
— gary viscio
February 27, 2004
I agree to fight it. I tried with my United Health Care exclusion, but
their exclusion is the worst. Also, talk to your employer. They my have
the power to make an exception to their policy rules. My employer is
self-insured and will not cover the surgery. Try your best and fight it.
It has worked for others.
— Terry Lynn W.
February 28, 2004
Go for it anyway and appeal if denied. As some of the other posters have
said make sure your doctor submits a letter of medical necessity. Those
exclusions are set by your company and not the insurance co. My sister has
UHC and was approved after the 1st letter with no problems. She never had
to contact the ins. co. at all. Good Luck!
— jacquie-dee
Click Here to Return