Question:
Exclusion for Weight Loss Surgery
If there is a clause that says "charges for surgical and non surgical treatment of obesity, including morbid obesity (such as gastric bypass surgery and gastric stapling.) These procedures are not covered regardless of the diagnosis. Does this include the Lap Band? — reece1028 (posted on August 3, 2009)
August 3, 2009
It includes all and any treatment for obesity, sorry. but it never hurts
to try. I would still have your doctor write a letter which includes your
medical history. good luck to you
— karrenn
August 3, 2009
Read your policy carefully. My pollicy has the same exclusion but if the
surgery is deemed medically necessary, then the surgery is covered.My Ins
is BCBS of Alabama, A PPO
My Primary DR has to wrtite a letter of medical necessity.
Keep researching. Those policies are hard to interpet sometimes. Call
Customer Servive and ask questions. Also chose a WLS seminar to attend.
They usally know about ins or call a dr's office you are interestd in and
explain what type of Ins you have. Where there is a will their is a way.
— polly_w15
August 3, 2009
It sounds like they will NOT cover any type of surgery for weight loss,
maybe if they can say it's for other related health issues but don't count
on that!!!!
— rkurquhart
August 3, 2009
Just because your insurance doesn't pay doesn't mean you have to give up.
It took me several years to come up with a solution, but I self paid.
Check out several surgeons...the costs vary greatly. Just comparisome
shop. One hospital I checked charged double what another did. I used what
was left of my retirement...figured I wouldn't need it if I stayed morbidly
obese anyway!
— jtoothman
August 3, 2009
I'm currently fighting wih my insurance company. When I started the
process back in March, wls was covered. April 1, the company changed the
rules without telling anybody, including the employer. Right now, I'm
filing an appeal. Good Luck in your journey. Believe me, I understand
completely.
— Kathleen W.
August 4, 2009
Hi. My company has Premera BC and the contract contains that same
exclusion. In 2006 I wrote appeal after appeal to no avail. I figured out
a way to pay for the surgery myself and am scheduled for 8/10/09 to have
VSG. So don't give up hope. I have heard that some people are able to get
around the exclusion and some arent. Give it your best shot and then look
for alternatives (financing, stock options, etc.). Do what is best and
works for you. Good Luck! Cin
— Cynthia W.
August 4, 2009
Hi Oseenia. I am another that was denied by insurance. Mt company has BCBS
og Ga. I went from HMO to PPo hoping my surgery would be covered. After 3
years and 40 pounds they still would not cover, even for medical necessity.
Thankfully my son, daughter, ex-daughter in law and myself all chipped in
and self paid. But do shop around. The cost varies so much. I even went to
another town, 100 miles away and saved over 10,000. with a very good doctor
and bariatric center. I even started to do the lap band which I did not
want just to save money and my son told me I needed to get what I thought
was best and not try to save and have to do it over. So when I first was
approached with self pay, I cried, I had no idea where I could come up with
that kind of money. But it happened, so don't give up!!! Pray about it. I
even started to change jobs to a company that offered the surgery!
— sallie H.
August 5, 2009
The truth is that if it is an exclusion on your policy, you are HIGHLY
unlikely to get your insurance to pay. It is extremely rare. I get
insurance approvals for weight loss surgery for a living and I tell people
that if it is written in their policy as an exclusion, they won't pay for
it because they don't have to. It's clearly written into the policy. But
it is worth it! If you can find a way to self-pay, DO IT!
— sandyriles
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