Question:
Does anyone know the exact requirements to have in order to be

HI. I have Ochsner total health choice insurance and although the policy does not specifically exclude WLS, it must be deemed medically necessary. I have called the insurance company several times and can not get an exact list of what qualifies a person for "medical necessity". If anyone has dealt with this problem before, I appreciate all information. Thanks, Stephanie    — Stephanie L. (posted on June 2, 2003)

June 2, 2003
Here's the definition my plan uses for medical necessity. Your's is probably similiar. "In order to be Medically Necessary, a diagnositc test, treatment, procedure, facility, item of equipment, drug, device or item of supply must be rendered in connection with an injury or illness, be consistant with the diagnosis and accepted treatment for which it is prescribed, be in accordance with generally accepted standards of good medical practice, NOT be considered experimental/investigative, and NOT be for the Member's or Provider's convenience." Hope this helps. Check your own Summary Plan Description; it might tell you more!
   — koogy

June 2, 2003
my insurance also had a similar statement of med. nec. as that listed below. I also asked them specifically WHICH co-morbids they accepted to prove med. nec. for a gastric bypass and they told me specifically. You pay for this insurance and they MUST not withhold info from you. Be more persistant - go over their heads if you have to!
   — [Deactivated Member]