Question:
A question whether you have this insurance or not...
I posted this question a good while back but received no responses, so here I am trying again. I live in S.C. and have Pacific Life and Annuity- Beech Street PPO. As of yesterday, I am now awaiting a response from them for approval. I have yet to find anyone here at AMOS that also has this insurance to at least get some idea how difficult they are (or aren't). When I initially contacted them about my needing WLS, I was simply told that all I had to do was have the surgeon send them the paperwork. Not wanting to just cross my fingers and wait, I want to know what my chances are. So, even if you do not have PL&A, please let me know what you think my chances are with this being what is stated in my insurance book regarding this surgery- "No benefit will be paid under the medical insurance for or in connection with the treatment of obesity, including, but not limited to gastric stapling, gastric bubble, bypass surgery, diet-based weight loss programs, exercise, or gym programs. For treatment of MORBID obesity and related medical conditions, the plan will pay for medical or surgical treatment of morbid obesity, but will not pay for weight loss programs or for any cosmetic treatments." I plan to contact Walter Lindstrom if I am denied because I feel that this is quite cut and dry. No exclusion for the morbidly obese. I just need reaurrance guys- I am a nervous wreck. Thanks for any comments. — karmiausnic (posted on July 11, 2002)
July 10, 2002
Karen--remain calm!! It looks like you'll probably be OK. I believe that
according to the BMI you have on your profile (51-52) that you are
considered morbid obese (just like me :), and they state in the exclusion
that they'll pay for the surgery/treatment...try your best to remain calm
and I'll keep my fingers crossed w/ya!!
— Lynda L.
July 11, 2002
Hi. This reminds me of when I called my insurance to see if they had an
exclusion (United HealthCare). They told me that they don't cover anything
for weight loss and went on to tell me that very few insurance companies
do. When I told them that many companies do cover weight loss surgery,
they told me only for obese people. So I asked them do you cover weight
loss surgery for obese people and the guy said that they do. Why he
couldn't say that in the first place is beyond me. They interpret weight
loss and obesity surgery as two different things. It looks to me like you
will be fine. Good luck!
— Shannon C.
July 12, 2002
You should be approve with your BMI alone. I have heard it takes up to 6
weeks for some to get approved.I hope not for you(or for me).Hang in
there,it will happen. Check out the insures section to see who has the same
insurance as you do and email them to get more details.
— yolanda W.
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