Question concerning insurance.

Bear with me because this is somewhat confusing; I'll try to explain it as best I can.

I recently got a BCBS of Oklahoma insurance policy through the ACA exchange website. From what I read through various weight loss forums it seemed like Oklahoma isn't one of the states that has to include bariatric surgery.

Then I started researching more about ACA and bariatric surgery and came across things like this stating oklahoma mandates that it has to be included in all policies on the exchange:

ACA Health Mandates For Obesity

NOFUSA Health Insurance Covers Obesity

(Here's a little background on the state benefit mandates; not required reading, but if you're interested):

State Benefits Mandates 

Well, here's the plan that I bought on the exchange; note toward the bottom it lists bariatric surgery as covered, no charge after the deductible, and under the "Limits and Exclusions Apply" popout, it says "Only covered if medically necessary."

 My Plan on the ACA Exchange

Here is what BCBSOK says about medical necessity and bariatric surgery. Note: This is just what BCBS of Oklahoma says in general about bariatric surgery; I haven't been sent this with my policy or anything like that:

 BCBSOK Bariatric Policy

Yet in my benefits book, this is what it says concerning bariatric surgery: (on page 48, under exclusions) Note: It's a sample page, but it says the same exact thing in my benefits book.

"For treatment of obesity, including morbid obesity, regardless of the patient's history or diagnosis, including but not limited to the following: weight reduction or dietary control programs; surgical procedures; prescription or nonprescription drugs or medications such as vitamins (whether to be taken orally or by injection), minerals, appetite suppressants, or nutritional supplements; and any complications resulting from weight loss treatments or procedures."

Insurance Policy Form

So, Oklahoma has to include bariatric surgery in their plans, mine does, but it's also excluded? What?

I emailed the National Obesity Foundation (the 2nd link I posted) patient advocates to see if they could make heads or tails of this. One of their lawyers got back with me and I sent her all of this information. It's the weekend so I don't know when they'll get back to me.

What do y'all think?

I'd start by calling the number on the back of your insurance card -- to see if it's covered and also what their requirements are (some insurers require a six-month medically supervised diet).

Insurance can be very confusing......at one point I had United Health Care - their website said bariatric surgery was covered -- but my employer excluded it from their policy.  Had to delay surgery until I got new coverage.

Hope you find it's covered!

Yes, you need to call YOUR specific insurance company's number and ask them about what YOUR policy covers.  A national entity is NOT going to be able to tell you what anyone's specific policy does or doesn't cover... They are going to refer you to your insurance company.

Since Oklahoma mandates coverage, though, it MUST be covered.

The page you cite (http://www.bcbsok.com/pdf/policy-forms/mspp-individual-on-sample-ok.pdf) says very clearly in red print at the top and bottom of EVERY page that it is a sample coverage document (and it has a huge SAMPLE watermark across every page) It is NOT related to your policy.

Lora

That might be a sample page, but it's word for word what's written in my benefits book that the insurance sent me.

If you have not done so, post this on the Insurance, Cash Pay and Financing forum also

I took your advice Kathy and posted it on the insurance forum. I looked for one before I posted but didn't see it for some reason.

I'm also going to call my insurance up after I gather a list of codes for all the different bariatric procedures. Have them run them through to see if I'm covered.

Honestly, I think 2 things are happening. The Oklahoma insurance goverment department is so backwards/pissed about obamacare that they aren't enforcing this (no party hating, I'm republican), or they're trying to pass Bariatric surgery off, in this case, as some type of life or death procedure. Like a gunshot to the abdomen, or colon cancer/stomach cancer. I'm still glad I got the NOF advcocates involved because something doesn't smell right.