Insurance and obesity coverage denials

[cryss 96]

This may best be catagorized under gripe threads, but essentially there are a lot of us who have exclusions on our health plans that will not cover anthing related to obesity, EVEN THOUGH it is recoginzed by the A.M.A. as a disease. The fact I find that unethical and absolutely messed up behind belief makes no difference, however, and it is what it is.

I casually mentioned I was drinking Slim Fast at a doctor appointment for an injury to my foot, and this detail made its way into my chart. I got a denial from my insurance and had to pay the entire cost of the visit out of pocket.

*insert expetives

As such, my wife and I had to clean out our 401K and take a huge loan for the upcoming WLS, and were glad to do so.

My question: Has anyone here written various representives and commissioners, raising the discriminatory issues that surround obesitiy that we find in the insurance industry? Even with recent breakthroughs involving pre-existsing conditions (and high five for that!), issues involving obesity are stilll often not covered.

I am gathering a list of indiviuals in various sectors to write such letters, even though I am just one voice. Granted, I like to think that the Butterly Principle is at work here... maybe one person may see the letter and affect change, even if it is long after I am gone.

I would like to hear any stories or any suggestions.

Thanks,

Cryss

Edited May 8, 2014 by cryss

[makemyownluck 785]

I agree that it's wrong to exclude obesity related treatment from an insurance plan, however if it's stated in your policy that it's excluded, then no amount of letters will change the insurance policy.

Many insurance companies exclude this because it saves them a lot of money and they can offer lower premiums. The same company can offer plans that have coverage for obesity and different plans that exclude it. Employers especially will exclude this coverage because it saves them money as well... the same goes for maternity coverage. The more you exclude, the more you can save, the more attractive your company/policy seems to whoever is in charge of selecting it (even though the insured is screwed out of medically necessary coverage).

I'm so grateful I had my surgery when I did as I lost my health coverage about 6 months post-op... but now I'm in the same boat as anyone else. I missed out on open enrollment for Obamacare and now no one will issue me a temp policy because I have a history of Hypertension in the last 5 years (I can't even get to the actual application to advise of my surgical history and how my blood pressure is totally normal now for over a year!).

The system is flawed on many levels... I'm sorry you're having to clear out your retirement to pay for your surgery, but in the end, it should be worth it. Good luck to you!!

[Jersrose43 837]

Most insurances are through an employer policy

Many employer based policies are self - funded and under the ERISA laws are able to cover and not cover whatever they want

The insurance offers a cafeteria style plan or Buffett if you prefer, and employer picks the meal he wants to buy.

He choose not to purchase wls

He could also choose not to cover chiros or acupuncture if they so choose

Ppaca/obamacare plans are required to offer a complement of minimal coverage. You can always purchase one, confirm it covers wls, and use it as your secondary plan to pick up the costs.