Insurance Update (x-post)
I have been "Officially" denied by my Primary Insurance (This is NO SUPRISE).
(Employee Benefit Management Service -a.k.a.-EBMS) Self-Funded thru my employer.
PRIMARY INSURANCE (They are a "self-funded" insurance company.)
DEFINED TERMS:
Morbid Obesity is a serious disease associated with a high incidence of medical complications and a significantly shortened life span. The current clinical standard measure for Morbid Obesity is a BMI (Body Mass Index) of 40+. The BMI is a factor produced by dividing a person’s weight (in kilograms) by his/her height squared (in meters).
PLAN EXCLUSIONS
Obesity. Care and treatment of obesity, weight loss or dietary control whether or not it is, in any case, a part of the treatment plan for another Sickness. Medically Necessary non-surgical charges for Morbid Obesity will be covered.
The doctor's office has fowarded it on to my Secondary Insurance. (Husband's insurance through Safeway) This happened sometime last week. So, my 30-DAY-WAIT has started all over again.
SECONDARY INSURANCE
PLAN EXCLUSIONS AND LIMITATIONS
No medical benefits are payable for the following: Services which are primarily for weight-loss.
-Jamie
edited for: insurance info
RNY 2/26/2002 DS 12/29/2011
HW 317 SW 263 BMI 45.1
SW 298 CW 192 BMI 32.9~60% EWL
LW 151 in 2003
TT 4/9/2003
Normal BMI 24.8 is my GOAL!!!
GBP (RNY) 2/26/02 298 lbs, TT 4/9/03 151 lbs, DS 12/29/11
HW 317 SW 263 BMI 45.1/CW 192 BMI 32.9/GW 145 ~ Normal BMI 24.8
**Revision Journey started 3/2009 Approved 12/12/11**
I edited the post. There was NO suprise from my primary. 2 other people in the company where I work have had WLS, and they paid cash for it. But, I did research out my primary anyways.
This is what the doctor's office was told when they called both of the insurance companies back in May:
"I did receive you inquiry and was able to verify your eligibilities and coverage with both insurances. Here is what I found out: your primary insurance states that they do not cover any surgical weight loss treatment, and when I asked your secondary about surgical weight loss treatment they said it is a case-by-case review and precertification is needed."
-Jamie
RNY 2/26/2002 DS 12/29/2011
HW 317 SW 263 BMI 45.1
SW 298 CW 192 BMI 32.9~60% EWL
LW 151 in 2003
TT 4/9/2003
Normal BMI 24.8 is my GOAL!!!
GBP (RNY) 2/26/02 298 lbs, TT 4/9/03 151 lbs, DS 12/29/11
HW 317 SW 263 BMI 45.1/CW 192 BMI 32.9/GW 145 ~ Normal BMI 24.8
**Revision Journey started 3/2009 Approved 12/12/11**
Cheers,
Cathy
Back in January, I went to my PCP, and he put me on phentermine, and I have been going to see him on a monthly basis.
You are more than welcome to check out my profile, it is all in there under "My Story" on the bottom of the page.
So, maybe I'll have good news before Halloween!!!!
But, yup..... WAITING SUCKS!!!!!!!!!
Take Care
-Jamie
RNY 2/26/2002 DS 12/29/2011
HW 317 SW 263 BMI 45.1
SW 298 CW 192 BMI 32.9~60% EWL
LW 151 in 2003
TT 4/9/2003
Normal BMI 24.8 is my GOAL!!!
GBP (RNY) 2/26/02 298 lbs, TT 4/9/03 151 lbs, DS 12/29/11
HW 317 SW 263 BMI 45.1/CW 192 BMI 32.9/GW 145 ~ Normal BMI 24.8
**Revision Journey started 3/2009 Approved 12/12/11**
