exclusion

skinnyjenny · August 19, 2006

I have been trying to find out from my insurance company why they do not cover the lap band. They kept calling it an exclusion, but...I found out from the Dr. office that will be performing my band that they talked with my insurance company and who ever she talked to said that it is not an exclusion. To me that is a big WOOHOO, or is it, what does that mean. To me that should mean that they should pay something. Can anyone help me so I know if it is a WOOHOO or a BOOHOO.

Thanks,

skinnyjenny:help:

Morsaille · August 19, 2006

My policy had a written exclusion... that is a BOO-HOO.

All insurance usually covers WLS, but employers can opt to add an exclusion. This way they save lots of money not paying for that coverage. It is not discrimination, it just feels that way.

Your insurance company probably covers WLS, but your employers policy excludes it. Check with HR to make sure.

Stitchy · August 19, 2006

Sounds like you need to do some more investigating. Not an exclusion for what? Gastric Bypass? Lap Band? A lot of insurance companies are just not up to date with Lap Band. I know fellow whose company said that it was *experimental.* He fought it. Got the letter from whoever the government agency it is that approves these things (I'm having a mind fart right now and can't think of it's name). Eventually, he won and three more people from his company had the surgery. You might have to be a pioneer.

Bettina · August 19, 2006

I have been trying to find out from my insurance company why they do not cover the lap band. They kept calling it an exclusion, but...I found out from the Dr. office that will be performing my band that they talked with my insurance company and who ever she talked to said that it is not an exclusion. To me that is a big WOOHOO, or is it, what does that mean. To me that should mean that they should pay something. Can anyone help me so I know if it is a WOOHOO or a BOOHOO.
Thanks,

skinnyjenny:help:

That doesn't sound right if its not covered, its not an exclusion...is just not covered. The exclusions for mine are psych eval (which they did pay..lol) and the dietician! Hmm I would call them and ask them what part of weight loss surgery has exclusions. Good luck! :biggrin1: