Question:
IS THIS EXCLUSION AIRTIGHT
My insurance policy is BC/BS PPO. In the exclusions is states: " Services or supplies related to obesity, including surgical or other treatment of morbid obesity." I also have several comorbidities, HBP, High cholesterol, depression, arthritis, ect. Am I fighting a losing battle with this exclusion? — TONJUA A. (posted on April 4, 2003)
April 4, 2003
I don't believe it is air tight. Go for it. All they can do is say no and
you still have the appeals process. Good Luck! Sincerely, Mary Beth
— Beffy W.
April 4, 2003
I have a similar policy on my primary BCBO of Oregon coverage. It's the
kind of policy you or your employer purchased. (Check to see how low your
yearly deductible is) My employer simply purchased a policy with that
exclusion. Yup, pretty air tight. Sorry. Do you have a secondary policy
through your spouse that might cover it? Good Luck
— Terrie G.
April 4, 2003
I have BCBS of NC PPO, make sure you read it in its entirety, because mine
says it does not cover services, supplies, drugs or charges that are for
treatment of obesity, EXCEPT for surgical treatment of morbid obesity. I
would fight it regardless-your life is too important not to! Wishing you
all the best:)!
— doit 2.
April 4, 2003
There is a lot worse that can happen besides them saying No, in my opinion.
You can get stuck paying thousands of dollars worth of pre-op tests that
the surgeon generally requires you do before they see you. My husband has
insurance through BCBS of Oregon. They have an AIRTIGHT exclusion to
ANYTHING related to weight loss. I wasn't aware of that when I started
looking into this procedure two years ago, and so I did what the surgeons
office told me to do. Nutritionist, Sleep Study, Pychologist..... THEN I
got a letter stating nothing would be paid for.
I'm not trying to sound harsh here, but I suggest you really read through
the policy before starting any testing or even meeting with the surgeon.
Getting stuck with $3000.00 worth of bills was not fun. Thank God I have
new insurance that is covering everything at alomst 100%.
Good Luck.
— J. Wilkinson
April 4, 2003
I dont have bcbs I am on United Healthcare PPO and they have the same
exclusion Surgical and non surgical treatment for obesity (morbid obesity)
is excluded and I called them and talked to them and they said that I could
have the doctor turn in my paperwork and because of my medical history
would probably be approved. I would call them and talk to them before you
give up hope and there is always appeal processes. I would think though
that the insurance company would rather pay 20000 than a lifetime of
hospital and other expenses. good luck:)
— harleigh2002
April 19, 2004
You didn't mention what state you live in but some states have state
mandated laws that make the insurance companies cover the gastric bypass
under certain conditions. I live in Maryland, and though my insurance
(MAMSI MDIPA)states the same exclusion as no coverage for morbid obesity,
they neglect to mention that our state mandates by law that if you are
morbidly obese and have comorbidities because of it, then they have to
cover because of the conditions it is causing, not the obesity. The
insurance companies neglect to inform of this hoping you won't research and
will accept it isn't covered. Check your state laws on the internet and
check with the insurance commissioners for your state. Wishing you the
best of luck.
— Alison K.
July 25, 2005
bcbs OF SOUTH CAROLINA,
Any medical Supply or service rendered to a member for the treatment of
obesity or for the purpose of weight reduction. This includes all
procedures designed to restrict the Member's ability to assimulate food,
such as, Gastric bypass, the insertion of gastric bubbles, the wiring shut
of the mouth and any other procedure the purpose of which is to restrict
the ability of a Member to take in food, digest food or assimiliate
nutrients.
Sounds like there maybe a way to go around this with the lapband in my
opinion. I'm not a lawyer nor do I play one on tv.
— Florence B.
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