Question:
Insurance question
If under exclusions on your insurance it says weight reduction or control ("unless there is a diagnosis of morbid obesity") does this sound like it's covered? Also about how long does it take most ins companies before you get approval? — [Anonymous] (posted on May 10, 1999)
May 10, 1999
a diagnosis of morbid obesity is an unusual and very welcome sign in your
health coverage. My surgeon and PCP wrote very strong letters to my insurer
(Oxford) stressing the comorbidities they were treating (incipient
diabetes, high blood pressure, worsening arthritis, lack of mobility, sleep
apnea, etc.) I don't know what they wrote but I was approved within a few
days. Many carriers are notoriously slow and disorganized and you have to
keep after them. Keep calling and always get the name of the person you
spoke with. If you are slowed down at all make sure you get copies of your
doctor's referral letters. Don't take NO for an answer at any time.
Sometimes they say no at first just out of habit. Appeal, complain, show up
in person, whine.... til they get their stuff together.
Good luck
Susan
[email protected]
— Susan C.
May 10, 1999
The "morbid obesity" is your outlet. Yes, it sound like it
is covered. You probably also have other problems making the
procedure medically necessary that your doctor or surgeon will
include in their request to the insurance company.
— dboat
May 10, 1999
Yes. As most surgeons won't consider you for the surgery unless you can be
diagnosed as morbidly obese, it is covered. If the insurance company gives
you any problems about covering after you have been diagnosed as morbidly
obese, you need to contact a legal representative and appeal the denial
based on the insurance exclusion cited here. As far as how long it takes
for approval, well, that's dependant on the insurance company. Mine
initially denied me in November of 1998, and now, I am going through the
final appeal process, which will (supposedly) conclude on the 18th of this
month. I wish you the best of luck.
— Molly S.
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