Healthnet PPO Exclusion?? Will they pay anyway????

Has anyone been approved through Healthnet PPO when the Gastric Bypass is considered a exclusion and is not covered? I am going forward with the surgery and paying for it myself and had assumed that insurance wouldn't pay for it because it's not covered under my plan. I found out that others are able to get their insurance companies to pay for the surgery even though the company says they won't cover it. Can anyone tell me the best way to go about that and if anyone has had luck doing that with Healthnet. Thanks!

Hi Kerry, My insurance was principal and they had a "written exclusion" in our policy and from what I'm told that's a complete dead end and you can't fight it. If they are just denying the claim then I believe you can fight it but a written exclusion is different. You might want to check your insurance for that. I am paying cash for my surgery and seems like it's an easier route. Good luck on whatever you decide to do. Renee'

Hi Renee, Thanks for your info. Yes, mine is a written exclusion also. I have been going forward with the process and have been paying ca**** does seem a lot easier and a much quicker process. Either way, I'm just excited that I'm doing it and I know the money will definitely be worth it in the end. Thanks again! Good luck to you too!

I have Heathnet PPO, violet plan. I called them myself and asked about it, they said they covered it and I would pay $300.00. I didn't believe it so I called three more times and talked to 3 different people. If you have MEDICARE Healthnet it is covered with the qualifications of BMI>35 w/co-morbidities or higher BMI, a reference letter from a physician (no type imperticular) and ... I think that was it. When I called they were going to give me a pre-auth number over the phone. They gave it to the hospital and physician right away. If you have EMPLOYEE CHOSEN Healthnet, the employee can choose what they want covered, if they don't want GBS covered than it isn't covered and will be excluded. Call the number on the back of your card, I'm sure you did but do it again. Each time I called I got a different person but in my case, the same answer.

Hi Under Tall, Thanks for the info. I called the insurance company several times and they said it was not covered. The company my husband works for has excluded it from the coverage. Oh well, I'm still going through with it and am really excited! Thanks again and good luck with you process and surgery!