Does Maryland Physicians Care pay for Bariatric Surgery?

Hello everyone.  My name is Ann.  I am currently just beginning the process of bariatric surgery.  I have Maryland Physicians Care.  I have many comorbidities.  I called the helpline at MPC to inquire if they pay for the surgery, and was promptly told they do not.  However, my doctor assures me that she has had patients with the same insurance, who have been approved and MPC paid for everything.  My doc has sent all info. to Johns Hopkins at Bayview in Balt. Md., and we're just waiting on a reply.  I'm simply asking this question of anyone who may have had this similar instance.  I don't want to get my hopes up too high, and then be let down.  But if there are positive stories, I'd love to know.  I more than meet the BMI requirements, and as far as other health issues .... High blood pressure, diabetes, degenerative arthritis, severe sleep apnea, foot neuropathy, and others.  So I'm pretty sure I would "qualify".  If anyone can help with info, while I wait impatiently for word ... I would be so grateful.  Thank you!!

Most insurance companies offer multiple plans.  Some cover weight loss surgery, some don't  In addition, some employers choose to specifically exclude WLS from their plans in order to save money on premiums.  Your insurance company is in the best position to know what your policy covers and what it doesn't, not your doctor.  Perhaps your doctor has had other patients with the same insurance company and their polices covered it while your does not.

Thank you for your replies ... I must apologize though.  I forgot to mention one important factor.  I am no longer employed.  Two years ago my health started on such a decline that I was deemed "disabled" about 9 months ago.  Maryland Physicians Care is a type of Medicaid from our government.  After being a productive member of the working force for over 40 years, I am now unable to work.  My weight had nothing to do with the disability approval, but I have gained SO much weight due to medicines, inactivity, foot neuropathy, etc.  I do not have Medicare ..... only Maryland Physicians Care (medical assistance, government issued).  I thought perhaps if anyone here has that same insurance, they may be able to give me some insight.  MPC says they don't cover it.  My doc says they do, because she's had a few pts. who have had WLS and they have the same insurance.  I'm just confused!  Thank you all for your imput.

Ann

Maybe they used to cover it and don't anymore?

I agree with your other poster. Unless your employer buys the rider for WLS, it will not be covered. It will be an exclusion and that sounds like what your policy is saying. 

It that is the case, all you can do is self pay. No. Amount of appeals will overturn an exclusion. Many have gone to MX for their surgeries at a fraction of the US self pay. Price,and received excellent care.

gL

Do you have access to your insurance plan online? Many plans let you log in to check your deductibles, find a doctor, etc. If you can find your plan-specific benefits book, that should contain specific information about whether or not bariatric surgery is covered.

If your insurance is provided by your workplace, you may also be able to contact HR for this information. You don't need to ask about WLS in particular, just ask if they have a list of procedures that are covered and excluded by your company insurance plan, and the HR person may be able to provide the information.

My situation is almost identical to yours... including the insurance!  I have just begun the process of trying to find out if MPC will pay for this surgery.  My PCP said he would write the referral if I can the DR.  Would prefer Johns Hopkins to any other hospital.  Did you ever get a answer for your surgery?  If you did any suggestions to someone about to head down the same path as you?

Thanks!

I have mpc and was told that the surgeon has to submit the medical reasoning behind me.needing it and wait for it to be approved or denied. Mpc doesnt just generally cover it. It has to be needed.under their standards even tho they dont have specific requirements