Question:
How do I find out if a specific insurance covers WLS? May benefit others

Ok, I have posted a few questions on here regarding guild insurance. I am trying to find out for the benefit of others on this site what is the best way to find out exclusions for a policy. I have called the insurance company and they could not give me any specific details regarding the exlusions on a particular guild that is covered. I am afraid to contact the insurance agent themselves that deal with the policy because I don't want them to know why I am trying to find out about exclusions. According to the benefits list I received, I did not see any mention of any exclusions. Is it likely that an insurance company would only provide the exclusions once you had signed up and paid for it? This is so important because many on this site cannot just go out and get insurance individually. Some states have high risk pools, but the insurance is horribly expensive. Any opinions are appreciated.    — Michelle H. (posted on March 15, 2002)

March 14, 2002
Each time I have called my ins co. during this oddessy I have said words to the effect of "I'm not trying to sound paranoid, but IS THERE ANY KIND OF EXCLUSION, etc. etc." and have been assured that there is not...I think it pops up automatically when they enter your member #. Now, I am going to have all my paperwork submitted next week and if they turn around and try to exclude me for any reason, I will go off so loud they'll hear me in CA...(I live in DC). What does this mean in your life? Not much, except that if your policy excludes WLS I think it's pretty clearly stated on the customer service reps screne, and they should be able to tell you right away. Good luck...
   — rebeccamayhew

March 15, 2002
This is what I did to get a diffinative answer... without letting the insurance company know what I was doing. I called up and asked that a "Certificate of Coverage" for my "Spacific policy that I was enrolled in" to be sent immediately... This is basicly a copy of the contract. It details what is included, and EXCLUDED....also it defined what the requirements were for a surgery that is excluded to be determined to be "medically necessary". Even if there is an exclusion (there is in mine) the wording gets to be important to see is there is a way for this surgery to be termed "medically necessary"... Good luck to you! Laura
   — laura B.