Insurance - Services Not Covered...Can you still be approved?

Hello everyone! I am a long time lurker, mainly just information gathering before I make the big decsion. I am 27, married, from the St. Louis Metro area, and have a BMI of 52. It hurts to type that One of the biggest things that have stood in my way of even considering WLS is insurance issues. I have "Healthlink Open Access II" insurance. In reading their "services not covered" list, this is the FIRST thing listed: "Treatment or service related to weight management therapy or surgery for treatment of obesity, including but not limited to complications that may arise from such treatment or service or office visits for weight management." So, my question! How many of you wonderful folks have had a similar exclusion in your insurance policies, and have been approved (I would imagine an initial denial...) later? Thank you in advance for any information, and many many thanks for all of the wonderful information I have learned from all of you! It is kindly appreciated

Jim, Welcome to the Missouri OH Board. I'm not sure of an answer but what I'd try if I were you is talking to the HR person at your work and also call the insurance company directly and ask to speak to the surgical approval specialist. Ask why they would exclude life-saving surgery and include all kinds of treatments for obesity-related co-morbidities? It may not get you anywhere and you must be just as sweet as Splenda, but keep repeating that getting your BMI down is the only thing that will save your life. I called, wrote and begged but my policy was not so definite. Still, the squeaky wheel gets the grease so I'd spend some time squeaking!!! Best of luck to you, Lana

Hi Jim, I too am from Saint Louis. I didnt think my insurance would pay for my surgery, however I went to Dr. Minkin at Des Peres Hospital. He is an awesome Dr. and he has ways with Insurance Co. If I can be of any help please feel free to contact me. My email address is [email protected]. Good Luck Ruthie

Jim, I have Healthlink Open Access II. They approved my surgery for RNY the first time around. Our policy said weight lose surgery was only covered if it was medically necessary. My surgeon and my regular doctor wrote the insurance letters of medical necessity. Plus all the forms my surgeons office had me fill out on the past weight lose attempts. Plus my husband called his rep and talked to them. Hope this helps. Sherry

Thank you all for replying! I am in the process of forming a "medical history" of my own to have at the ready, as well as have already contacted insurance liaisons for WLS centers in my area. I am getting second opinions from new doctors, as the old have already told me that WLS is my best option for life. Once I have my proof, and have decided on which doctor will be my champion, I will hit the insurance. My husband and I have had long talks about this the last several days, and I think it is time we actually do it, rather than just talk about it. He supports me 100%, and is ready to be my sidekick in this journey. I am under his insurance, so, it may be a little hard to get through to his HR, but, he has already committed to it. Yay! BTW...my name is Jill...JMT are my initials ;) Thanks!