Question:
i found out today............more please read

My insurance said they DO cover the surgery. I have BMI of 40, several co-morbs and very strong hx of diabetes, HTN, and heart disease (dad died at 45 yrs old). The only problem is how they dr submits the claim. My problem is that I can't see any way they can submit it, except morbid obesity as the diagnosis. Then the insurance might not pay, that is our exclusion. Strange they cover the surgery but don't cover morbid obesity. Why else would anyone have WLS???? If anyone has ANY sample letters they sent to insurance or a cost analysis please forward to me at [email protected]. I have a feeling this might be an uphill battle, but since my insurance is self-funded through my employer I am ready and willing to fight tooth and nail......or find another job. After all we nurses are supposedly in high demand........lol. Thanks to anyone that can help me and good luck to you all    — Laura S. (posted on November 7, 2000)

November 7, 2000
Laura...take a deep breath and relax! Your surgeon and his/her staff has experience in dealing with insurance companies. They will write a letter requesting pre-approval based on co-morbs because that is the best way to get approval. If they don't then find a surgeon who will. If you can't trust your surgeon to do his/her best for you in that regard then find another surgeon. Best of luck to you.
   — Watcher L.

November 7, 2000
Doesn't make much since to me! Most insurance company wont cover the surgery unless you meet certain critiera such as being at least 100 lbs over your ideal body weight and a BMI of 40 or more ... If you meet that criteria, you are clinically "morbidly" obese. I would check further with your insurance company ... usually the surgery is only available for the morbid obese.
   — Donna H.

November 8, 2000
I can imagine how you feel but what you need to know is that the insurance co. is trying to give you the run around. I totally agree to let your dr. office handle the situation because they are not going to give you the correct info and that is meant to discourage you. Please look on my profile page and read what my insurance co. did as it will hip you to their tactics. Much Love.
   — TANGIE B.

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