Question:
Insurance Policy with exclusions
Hello all I'm kind of reposting this question out there again because I believe I may had confused some potential supporters out there. I have BCBS Healthkeepers and I looked over my policy and found out that it excludes anything about obesity. Does anyone know if the doctor could help or is it anything that I can do. This is something that I really want to do I need all the support I can get. Thank you to anyone who responds. Katrina Bowles — Lovemyself (posted on November 24, 2007)
November 24, 2007
IF your regular doctor knows your health history, I'm sure he/she can
attest to some medical conditions caused by being heavy. It's these
conditions AND the weight that normally will qualify you for surgery. If
you can't get your doctor/health plan to cooperate, you may want to
consider changing health plans in the new year to a health insurance
carrier that does authorize weight loss surgery. Most carriers seem to
prefer the roux-en-y, since it seems to have a higher success rate.
— Dave Chambers
November 24, 2007
My insurance policy also 'excluded' all things related to weight loss.
Medical necessity was the way we got them to approve the surgery which only
took about a week. I had to document all ways I tried to lose weight, each
'diet', each exercise plan, etc. that I'd used for the past 5 or more
years. I went to the surgeon completely prepared which they liked and they
worked to get me approved quickly.
— Kathy T.
November 24, 2007
Most insurance policies are limited in many ways, however there is a way to
circumvent this process. You need to list all the medical problems you have
related to your obesity and justify your surgery for the alleviation of
these problems. This is not only a weight loss surgery, but a surgery to
alleviate the many complications that arise because of being obese. Studies
have shown that morbidly obese people stand a 40% greater chance for early
death from the complicating medical conditions that accomany this
condition. By alleviating the condition you are saving your insurance
comany in the long run. they will not be paying to treat your many
complications that arise. I myself had medications that cost me almost
$2,000.00 a month to fill. They were more than happy to eradicate the
conditions that caused me to take the medications. Now I take my vitamins
and my Hormones (menopause never goes away, dang it...) but they are so
very happy to fill them because I am much healthier, and it has not yet
been a year. My back pain is imroving every day, my apnea is imroving, my
triglycerides have normalized and I am much better off. By working to
remind them of what they stand to gain, they are usually happy to take the
small loss up front. It is a process that takes time, but in the end it is
an achievable goal. Good luck to you in your journey! I am praying for your
success.
— Sandra L.
November 25, 2007
The right doctor makes a huge difference. I was denied twice going through
one doctor and accepted the first time going through my current doctor.
Under our insurance policy it said that it had to be medically necessary.
Good Luck!
— MySonsMama
November 25, 2007
Katrina, I am very interested in the outcome of your plight. My daughter
has BCBS also and her policy likewise has a exclusion. She is close to 300
lbs and needs to have this surgery. I had the surgery in March and I am
down to 143 lbs. and diabetes is GONE. Please consider personally emailing
me at [email protected] as I am very interested in how she should approach
this unfair situation.
— Txgal8437
November 25, 2007
I would speak to the people at your surgeon's office. They usually know
how to jump through all the hoops!
— robinmarra
November 25, 2007
Katrina,
It's not the insurance company it's your employer that chose not to include
coverage for treatment of obesity. Now if your surgeon writes it up as a
medical necessity and have the backing of your primary care physician.
Don't try to take on the insurance companies until you have to and so to
save you some stress factor, allow the physicians to do their thing. See
if there is some medical necessity clause in your insurance, also see what
your state insurance commission states about morbid obesity as well as how
does your states' health department define obesity. You can fine this out
by performing a search on your states website using morbid obesity as key
word search. Good Luck
— the7thdean
November 25, 2007
Check if you have coverage for morbid obesity I ran into this problem with
BCBS, as I had coverage for morbid obesity but not obesity. Make sure they
are using the correct ICD code when submitting to insurance.
— Kanisha-B
November 25, 2007
my insurence also listed mit as an exlusion but they did tell me i could
try to have my doc deam it as medically necesarry. they can tell you
everything you need to get them as fara\ as paperwork goes. if you have
diabetes or high blood pressure or any thing else, you should use that as
your diagnosis code on your letter from your doc and not diagnosed with
obesity. my insurence told me that trick is something they look for.
good luck
— JACKIESMOM
November 27, 2007
Hi Katrina,
My insurance to had an exclusion. I went to obesitylaw.com. They are
wonderful people and can tell you if you have a chance of fighting and how
to do it. They got me approved after 4 appeals. They are so nice.
-Pam
— Pam_B_OR
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