Question:
Tell me what you think....
EXCLUSIONS: Drugs services and supplies related to the treatment of obesity. weight loss or weight control; however this does not exclude surgical treatment of morbid obesity for a life threatening condition. What are your opinions.. should I get approved pretty effectively with few comorbidities? Thanks alot! — vwilhoite (posted on May 1, 2002)
May 1, 2002
Hi...Don't quote me, but seems that if it is medically necessary (and if
you meet the requirements and are morbidly obese), the surgery would be
covered. In reading the info, this is what is sounds like. Did you give
the insurance company a call? You can call them and ask if they cover for
gastric bypass surgery and they will tell you if they do and their
requirements. Good luck.
— Giovanna G.
May 1, 2002
My insurance policy looks very much like this and I was approved without a
problem. My policy also included specifically what conditions had to be
met. 5 years of MO, 3 years of physician-supervised weight loss attempts,
and co-morbidities. Ask your insurance company to send you exactly what
conditions you have to meet. If you have something from them, in writing,
it might give you a basis for appeal if they deny you. What you have
quoted is pretty ambiguous and unless you have something in writing, they
can always say THEY don't believe it is medically necessary, no matter what
your doc says. I'm not saying they will do that, but different insurance
companies and even the same company in different states can be quite
different in the way they handle WLS.
— garw
May 1, 2002
I don't have much experience with the way ins. approvals/denials/exclusions
because my ins. was very quick...but it sounds to me that you have a damn
good chance. What are your co-morbidities? They say life threatening...my
only co-morbidity was hypothyroidism...as far as I know, that's not
life-threatening (is it?? :o)
Good Luck~
— Kristin R.
May 1, 2002
I'm not the best reader, however it seems to me it says "WLS IS
covered IF it is nessarary for your life". I think you have a great
chance.
— Danmark
May 1, 2002
Sounds like you should be covered if you have any major weight related
health problems. If you Sleep apnea, high blood pressure, high cholesterol,
pulmanary obstruction (such as asthma), diabetes, etc, should qualify you
for approval, as those can all be considered as life threatening if not
treated.
— Dell H.
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