Insurance has exclusion for all obesity treatment

[princess_sophie 0]

My insurance has an exclusion for all obesity treatment. Which means that if I want to do this I will have to self pay $17,500. That will cover the first year of all post op and fills. My concern is, if I'm self pay and I have complications during surgery or even a couple of years after and the band has to be removed, will i have to self pay all of that too?

I need help. I posted a similar post on the general discussions board, but I thought I would post a few different places to try and get more response. Even though I'm not sure if anyone can help me. I'm just really disappointed. :faint:

[Morsaille 4]

Sorry Princess Sophie. I had a written exclusion, too. I self paid in Mexico after completing all the pre-testing up here. They added my exclusion while I was waiting for the sleep-test... aargh!

This probably means that if your insurance coverage remains unchanged future costs will be yours alone as well. If you have complications that may constitute a 'medical emergency' instead of 'obesity related services', you should have some grounds to expect coverage; even if it requires an appeal.

Some people have had luck contacting Obesity Law and Advocacy Center

Others have had luck appealing by proving medical necessity with BMI and medical history. This depends on the insurance, mine was run by soulless b*****ds.

You'll get through! It is expensive, frustrating, and sometimes painful, but it works.

[divaga75 0]

I went ot a siminar recently and the answer is yes. If you have complications you will have to pay out of pocket for that. What you pay out of pocket is just for the post op,surgery, and first year. Anything after that is on you. That's what the Dr. out of El Paso said. I think each Dr. is different though. Hope this helps some.