Question:
Condition that causes weight gain?
My insurance (Blue Cross/Blue Shield) at first said they covered surger if medically necessary. Now after first denial they are saying that they only cover if I have a condition that causes the weight gain. Has anybody ever heard of such a policy? — SJP (posted on March 3, 2003)
March 3, 2003
Are you sure they aren't asking for Co-Morbidities? Many insurance
companies will cover the WLS if you have a BMI over 35 with one or more
co-morbities (obstructive sleep apnea, hypertension, diabetes, heart
disease, etc.)
If I were you, I'd get a copy of the policy and read it for yourself and if
you're still unsure, discuss it with your PCP.
— Carolyn M.
March 3, 2003
I think too that they must want co-morbidties. I have BC/BS PPO. They want
to know all your health conditions. You need to go back and find out
exactly what they want . Good Luck!
— Debbie W.
March 3, 2003
I also have BC/BS (PPO) and was approved after my first consult. My only
advice is to ask specific questions and, when you hear a bunch of insurance
baloney, ask again! I found that when I included examples to explain my
questions, I got a much more specific answer. Don't give up!
— Jodie P.
March 3, 2003
I agree, ask questions and find out what they want, specifically.
Insurance companies (more than anyone) should know better, my goodness if
there was an actual "known cause" there would be alot of rich
people out there selling us the "FIX" I wish you all the best,
you probably just need to be more specific on a question or two.
— Dana B.
March 3, 2003
Thanks for the responses. BCBS came back with that answer after getting a
letter of medical necessity from my surgeon. This letter included
co-mobidies and BMI (46.9)
I've also been trying to get a copy of the exact wording but for some
reason they keep telling me that my company has this. When I asked my HR
dept they just quote what BCBS has about "obesity" but not morbid
obesity. I just sent for a copy of the whole policy from BCBS. The whole
thing seems a little suspicious. Almost like some secretary called my
surgeon and gave some excuse.
— SJP
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