Scott & White - Is there any hope???

[nana2_iv 0]

Has anyone been denied because of an exclusion to WLS, applealed, then denial reversed...I thought I'd ask before I put alot of work into trying to get approval.

[ait 0]

I have not heard of anyone getting approved when there was an exclusion against WLS in their policy. There was an exclusion on my policy last year and they told me it is not even a discussion.

[RestlessMonkey 7]

An exclusion to the policy means that the service is excluded...it is NOT covered. Either your employer elected to exclude WLS or the insurance company never offered coverage. It would be as if you went to buy a new car with cloth seats and then decided to sue because the seats weren't leather. The deal never included leather seats...you bought "cloth". This is the same thing...the payment for your coverage does not include WLS. SO ...no, appealing won't help you. Sorry!

[changing 2]

I have Aetna who covers WLS but my employer opted to exclude it.Even after talking to them about this and them meeting with their insurance broker that still put an exclusion on the policy.so there is no hope of them covering it.but i am still looking at other options.

[nana2_iv 0]

I have not heard of anyone getting approved when there was an exclusion against WLS in their policy. There was an exclusion on my policy last year and they told me it is not even a discussion.

Did you have the surgery?

[ait 0]

Quote:

Originally Posted by ait

I have not heard of anyone getting approved when there was an exclusion against WLS in their policy. There was an exclusion on my policy last year and they told me it is not even a discussion.

Did you have the surgery?

I talked to my HR department about adding WLS to the policy at the start of the next year (2009) and miraculously it did getting added. So I'm scheduled for surgery on March 9th. I did all the insurance requirements in 2008 on the off chance that my policy would change, and I'm glad I did b/c it meant that I could move ahead more quickly.