Can you appeal if there is an exclusion?

[ATRAVOLTA 0]

I just found out last night that my employer has an exclusion for weight loss surgery on my insurance. Does that mean that my hopes of getting it covered are over or can I still appeal an exclusion? Thanks!!

[DrewsLou 3]

I honestly don't know how you could appeal if weight loss surgery is specifically excluded.

Good luck!

[Lap_dancer 8]

I just found out last night that my employer has an exclusion for weight loss surgery on my insurance. Does that mean that my hopes of getting it covered are over or can I still appeal an exclusion? Thanks!!

Go to the Blue Cross Blue Shield thread under INSURANCE. There is a quick jump to that topic at the bottom of the site with a drop box to open and click to that topic.

I have an exclusion. It's plain as the nose on your face. "no matter what" it is not covered. I did appeal all the way to the state insurance in my case and was denied, denied, denied. Now, having said that, just because I'm a hard a$$, I encourage everyone to appeal their adverse decisions because you never know what can happen, you build awareness within your insurance company that may lead to change C) it doesn't cost anything but your time. D) I like to just mess with 'em when some idiot company has such an exclusion that would ultimately lead to healthier patients (are they complete idiots to not cover this????) I did have a Plan B and Plan C. Plan B was to ask my employer to purchase a rider to my insurance so that I could have the surgery. They tried and I love them for it. My insurance told them NO. Plan C was self pay and fly to a surgeon I would pick.

I look at this like an investment in ME. We buy cars, homes and think nothing of getting a loan for it. Is it so far removed to get a loan for ME? Heck no! Think what I'll recoup in the long run!!!

Hope this helps.

[bethicle 0]

I have been denied by my insurance for the lap band, not because of an exclusion because I dont have a 5 year history of a BMI of 40 or above, and the lady that deals with insurance at my Dr.s office said that she could appeal anything but an exclusion.

[Lap_dancer 8]

I have been denied by my insurance for the lap band, not because of an exclusion because I dont have a 5 year history of a BMI of 40 or above, and the lady that deals with insurance at my Dr.s office said that she could appeal anything but an exclusion.

An exclusion means WE DO NOT COVER IT. I would give the denial letter to the doctor's office and have them draft an appeals letter. TRY.

[Wheetsin 714]

You can try, but you're probably not going to get anywhere. Appeals are most effective when you're trying to get your insurance to agree to cover something. Exclusions are -- well, here's a very simple version. When your employer wants coverage, they get bids on the coverages they want and what it will cost them. Sometimes to save money or because they just don't want the coverage, whatever the reason, they will opt to drop certain coverages. These are called exclusions. When an exclusion is in place, it means that your employer has declined to pay for that coverage. There's NOTHING the insurance companies can do about this. Asking an insurance company to pay for something that's excluded is like walking into a store and expecting to walk out what things you haven't paid for. It just isn't going to happen.

So what avenues do you have?

The option to exlcude is owned by your employer. You can try asking your employer or HR rep to reconsider the exclusion, but one person isn't normally enough of a driving force tfor them to reconsider adding the expense.