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I believe that if you need/want the surgery, you can get it...regardless of the "new" health-care. If they make you jump through hoops, then become an expert jumper. I was made to do the jumps and did them. I made a friend AT the insurance company (back in 1995) and she got fired for 'helping my paper work get to where it needed". She was overweight and wanted to have Gastric Bypass, too. I finally had to find the CEO of that Ins Co and made a call to HIM...and told him ALL that I'd done to get the surgery and HOW much it would save the same insurance company in my next 40yrs of not being fat. I asked him IF I needed to contact an attorney and he OK'd the surgery. It was a 2 year jumping through hoops, but I won! If you will get a notebook and keep every bit of paperwork, each person's name and date/time you spoke to them and what you spoke about, you'll have some ammo down the road.
I still believe that Bariatric Surgery changes lives and also keeps us out of the doctors offices with diabetes and hypertension AT LEAST.
Hope it helps~NEVER let someone tell you NO, who doesn't have the power to do so in the first place (as the workers in the insurance companies).

My insurance company approval took 2 days.  I am diabetic,  have sleep apnea, PCOS, arthritis in both knees. I take 4 meds a day. It is better for them to pay for WLS than pay for my long term effects of illness caused by or made worse by obesity.  I think SMART insurance companies are learning this. 

BCBS of NC approves very quickly, but that is because they realize the long term benefits, and the money they could save in the long run.

I had Lovelace in NM and had no problems getting approved with being diabetic......

worth appeals if you need too..

Cowgrl

I have SummaCare.  It is an Ohio based company but I do know they sell insurance in at least two other states:  Flordia and Vermont.   But like the others said.  It is not necessarily the insurance company.  Employers can add or subtract specific riders from their coverage.

I  have Magnacare through my husbands job... got approved in 6 hours... I have pcos & high blood pressure... I agree the ins. comp is realizing less weight  = less they have to shell out.

 Most insurance companies have a policy paperwork that they give you which outlines what your policy covers and what it doesn't.  I've been on these boards for quite a while and there are some insurance companies, or policies that don't cover the procedures.  It's really based on where you work and the insurance they provide at your place of business.  There are hoops to jump through because you have to be fully committed and they need to know that you have the knowledge to understand what you are getting into.  However, thee are also plenty of people on these boards who have gone to Mexico to have the procedure because either their insurance company doesn't provide the coverage or they don't want to have to jump through the necessary hoops.  

Keep in mind that even thoough several people on this board may carry a specific insurance carrier through work (ex. Aetna), the policy itself is NOT identical from company to company.  While I had Aetna cover my WLS, other companies want to pay a lower premium to Aetna, therefore, they state in their policy that WLS is NOT allowed.  I am hearing more and more people on the OH board complain about this, however, I don't think they have much of a leg to stand on. 

My personal take is that insurance companies always make you jump thorugh hoops.  I have been processing claims for one of my employees for workman's comp and I can't believe the amount of paperwork, doctor appointments, etc. that are required.  While I don't think they are "throwing out the paperwork" I think the process itself frustrates people and I am sure that some people just give up  I have a friend from Puerto Rico and he was having difficult getting reimbursed for some doctor bills and he was out of pocket $600.  He was so frustrated that he said he gave up.  I pretended to be his wife (he gave me permission) and I called the insurance company and we sorted out the problem (we just had to send a couple more documents) and he got the money he was entitled to.  Darn ... I should have asked him for a cut of the action! 

It is a game .... the one who doesn't give up first .. WINS!  By the way, I had to fight my insurance who failed to tell me there was a $10K bariatric surgery cap and they wanted ME to pay .... are you ready for this ..... $55K out of pocket.  Four months later, several letters and phone calls and I was victorious. 

You must be joking if you have ANY faith that most insurance companies aren't trying to screw the morbidly obese, because they can and they do.

They deny for every and any reason and most of the time for no reason at all.  YES they just throw paperwork away.  YES they deny even if you meat all the requirements.  They are hoping you'll give up and go away, will lose your job and thus your insurance, will change insurance or will DIE before they have to spend $30K in this quarter to save your life.  YES they are trying to save a buck, and NO the morbidly obese are not considered a worthy class of patients (like, yannow, kids with cancer or something) such that they have the least bit of concern about a public relations scandal if someone were somehow to get someone in authority or with the press to give a rat's ass about how we are treated.

I spend HOURS each and every week helping people get insurance coverage for the DS, pro bono.  Am I bitter and hateful toward insurance companies?  You bet your ass I am.

It appears that I may have won the reconstructive surgery battle, at least the part that I was fighting, but I can't talk about it while settlement discussions are going on.  See pages 24-26:
http://dmhc.ca.gov/library/reports/med_survey/surveys/300ful l031411.pdf

The Plan acknowledges that surgical procedures to remove redundant skin following weight loss from bariatric surgery may qualify for coverage as "reconstructive surgery" under Health and Safety Code section 1367.63 if the redundant skin constitutes abnormal structures of the body caused by congenital defects, developmental abnormalities, trauma, infection, tumor or disease and the procedure is to either improve function or create a normal appearance, to the extent possible.9 The Plan also acknowledges that it will not deny authorization for such skin reduction procedures on the basis that morbid obesity is not a disease within the meaning of section 1367.63.

I'm not sure this is the end of it yet, however.  The next fight is going to be about what "abnormal structure of the body" means.

When you are ready to submit for insurance coverage, you are going to need a letter of medical necessity to go with it, either from your PCP (if you need a referral and preauthorization to get to see the surgeon), or your surgeon.  You should ask for the doctor who is preparing your LOMN to see a draft before it is sent, and then send it to me.  A poor LOMN can screw you! 

But there is a lot of work that needs to be done first.  YOU need to write your own letter, detailing your medical history, BMI history, compliance with requirements for your first surgery, current problems, and why you need to have a revision.  You also need to figure out if your insurance has limitations on (1) bariatric coverage at all; (2) coverage for revisions (many insurance companies have a "one-bariatric-surgery-per-lifetime" limitation); (3) restrictions on access to the DS, e.g., only for BMI >50.  It is unlikely that an exclusion of bariatric surgery can be overcome, but the other two can.  But if you have them, you need to address them UP FRONT and not just with a generic LOMN - but your PCP or surgeon won't do this for you - YOU need to provide this information for him in advance, via your letter, which you will provide to the doctor to help write his LOMN.