Question:
Insurance exclusion
My insurance states it excludes weight reduction programs including all related diagnostic testing and services. Anti-obesity medication, including but not limited to, appetite suppressants and lipase inhibitors. It states my benefit plan will cover Medically necessary services directly realted to the following specific medical conditions and subject to the following benefit limits. Morbid obesity is listed. I plan on calling my insurance but wanted some input from you all first. BTW, my BMI is 49 — betsy09 (posted on February 25, 2009)
February 25, 2009
May I make a suggestion? When you call your insurance company, don't
settle for the first person answering the phone(even when they keep you
waiting a few minutes.) Ask for a supervisor. They're the ones who have
been at the company awhile and have more knowledge(hopefully) about you
need done
— Kathleen W.
February 25, 2009
I never called my insurance company to discuss what I was wanting to have
done. My doctor recommended it and I let True Results handle it from there
once I got the ball rolling and decided to have the surgery. There was
however alot of things that had to be done in order for my insurance to
even think about covering it first. Most insurance co. require at least 6
mths of a weight loss program to see if you are dedicated in losing the
weight. Important thing to remember when dealing with them is don't take no
for an answer. Obesity is a disease and you have a good fight to become
healthy. So if they deny you the first time have your doctor send another
letter. Keep on keepin on!! If worst comes to worst alot of the
organizations like the one I went through have a payment plan. Afterall
can you afford NOT to get healthy? GOOD LUCK!!!
— LifeisWonderful
February 25, 2009
I know its an extra expense but ObesityLaw.com. they are great and they
helped me get my approval after being denied for the insurance exclusion.
They are wonderful people.
— Pam_B_OR
February 26, 2009
I just recently got approved and my insurance listed it as an exclusion
too. I started my process by calling my insurance company and fortunatly
was connected to the right person who explained that WLS is approved when
deemed medically neccesary and she told me what the requriments were. They
are a BMI of 40 or higher for 5 years other contributing factors were high
blood pressure, sleep apnea, arthritis, diabetes and some others. I had a
few of these enough to qualify. When the surgeons office called however
they were connected to the wrong person that told them it was only an
exclusion and almost stopped the process right at the beggining. We called
back and the person I spoke with said they neede to read farther down the
page. So I would suggest calling your insurance and finding out what the
qualifications are and keep pursuing until you get the answers you need. I
had to stay on top of this process and made a lot of phone calls to make
sure info got where it needed and it has paid off. I hope everything works
out for the best.
— Lisa von Wallmenich
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