Question:
Insurance exclusion

My plan's exclusion reads: "The plan doesn't cover charges for weight control drugs, supplements or surgery - including morbid obesity." My BMI is 54; dyspnea, joint and back pain, hypothyroid (autoimmune), reflux, hypoglycemia. Is there any hope for me?    — Meg L. (posted on December 18, 2002)

December 18, 2002
Hi, I think most if not all policy have that clause. I just personally had a bad experince with UHC while others in the same company got approve on the first try with Cigna and BCBS. Have your pcp write a strong letter, make sure you document all the weight loss programs that you have been on especially doctor-supervised, have copies of medical diagnosis for comorbidities and have a strong letter from surgeon and start the ball rolling. Although I had a bad experience I have read other profiles that were approved on 1st go around with uhc and had that same clause. I've switched to BCBS for next year and prayerfully am able to get approved. Good luck and be optomistic.
   — vesta D.

December 18, 2002
My first reaction would have been you do not stand a chance. But, when I was at the surgeon's orientation the insurance person in his office said it was still worth filing an appeal because it forces them to look at your case individually. The other poster had good advice. Go for it!
   — zoedogcbr

December 19, 2002
I would at least give it a try. Especially if you have serious weight related health problems. Although my insurance didn't have the same exclusion, I had to fight for approval despite the fact I started out at bmi of 63 and had 6 of the 7 health problems that the NIH says qualify you as being medically necessary. I ended up hiring Walter Lindstrom through obesitylaw.com and got approved. They state that if you do have serious health problems related to your weight, that a company can't discriminate against you if the best treatment for those problems would\ be WLS. It may be worth a check. Don't give up so easily. I am now about 9 months post-op, down 135 lbs and feeling better than I have in years. It was a battle getting approved, but it has been well worth it. Good Luck.
   — Dell H.

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