Question:
Exclusions: Surgical and non-surgical treatment of obesity- Has anyone ever beat this?
Exclusions: Surgical and non-surgical treatment of obesity, including morbid obesity. I called my insurance company and they said if medically necessary it should be approved, but I would have to send a pre-determination letter. Please help. — Tonya D. (posted on April 3, 2003)
April 3, 2003
My insurance said the same thing for obesity but under morbid obesity it
said they would cover one per life time per member. I was approved today
for the surgery.That is the key words "Morbid Obesity" not
"Obesity". I don't think you will have any problems. Best of luck
to you.
— Angel S.
April 3, 2003
Since your policy also excludes MO it just will mean that your surgeon or
PCP, whomever will be writing the letter asking for approval, will need to
their job and do it well. It must have weight, BMI, any and all
co-morbidities (worst listed first), how this condition is affecting your
life, references to clinical data that indicates that WLS is the most
effective way to achieve long-term weight loss, resolve the various
co-morbs etc. My surgeons form letter has all of these references and they
just pick and chose which ones apply to you. I also think it is critical
to include a fairly detailed diet history even if it is prepared by you and
attached to the letter. The more you can hit them with to see the light
the better chance you stand of an approval. If need be write the darn
letter yourself and give it to your surgeon or PCP if they feel it is too
much work otherwise. Personally I think the letter coming from the surgeon
with a supporting letter from your PCP is the best way to go. The PCP's
don't usually put in all the medical references that the surgeon should
have readily available.
— zoedogcbr
April 4, 2003
I tell you what, I have the same insurance and the very same exclusion. I
talked to Dennis from United Healthcare last week and he said to send in
the paperwork and because of my medical problems it would probably be
approved. Dont give up on them. So far they have been very good to work
with so I think that it will work out.:) Good luck to you. email me and let
me know how everything goes:) jeannie
— harleigh2002
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