Question:
Have you been told that their is an exclusion for this type of surgery in the policy?

My insurance(Blue Cross PPO)has an exclution in the policy with anything to do with obesity. They won't cover the surgery. I had the surgery scheduled for June 5th.    — Ilen E. (posted on April 23, 2002)

April 23, 2002
I have bc/bs ppo and I called and asked them, they said they will cover it as log as it is medically necessary
   — Lisa W.

April 23, 2002
Do you have any weight related health problems? If so then it should be considered as medically necessary. Also does your policy specifically exclude weight loss surgery. If not, Morbid obesity is considered a different health diagnosis and may be covered for WLS if you have serious health problems. I would recommend appealling any denials and get the denial and policy in writing. As a last resort, you may want to hire Walter Lindstrom. (obesitylaw.com) According to his wedsite, he has about 50% approvals with companies that specifically exclude WLS. It may be worth a try, but don't give up the fight. That is what the insurance company is hoping you will do.
   — Dell H.

April 25, 2002
I am freaking out! I feel I can't figure which way to turn. I have only made one phone call to a surgeon to RSVP for a seminar. My best friend is 2 years post op and is beautiful! I am currently on diet pills. (BMI 42.1) And yesterday, for the first time in 6 months of medical treatment for obesity, my EOB came with a remark saying treatment and surgery for obesity is not covered under my plan. They have never put that on an EOB before and all my dr. visits have been applied to my deductible as medical expenses since October). I can't figure out if I should call before I go to a surgeon or let the surgeon's office handle it with their expertise. I have major medical insurance, but after reading some of the messages, sounds like if it is medically necessary you can get approval. I am afraid of calling the insurance company before hand, and ruining my chances of approval. (Does that sound stupid?) Should _I_ call my insurance company first to find out?
   — Laura S.

April 25, 2002
It won't jinx you to call the insurance company. In fact, it's a good idea. Just make sure that you tell them to send you whatever they tell you in writing. There's really no way for anyone to give someone else a definitive answer on insurance issues unless they work for the same employer, in the same state and have the same version of the policy. Your human resources department should also be able to give you a copy of the policy.
   — garw

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