Can anyone explain this?

Does this mean I may be able to have surgery if my doctor says it is necessary? I'm confused and I do not want to get excited if this is saying that I may not have a chance. Services Not Covered By The Plan All services, supplies, and prescription drugs related to obesity or weight reduction except: 1. medically necessary intestinal or stomach by-pass surgery, or 2. medically related services, excluding prescription drugs, provided as part of a weight loss program when weight loss is required by the covered person's surgeon before performing a medically necessary covered surgical procedure. Coverage for these services is limited to $150 in any 12-month period. Thanks for any help, Fee

Sounds to me if your docter says its medically necessary you will be covered. But if I were you I would call the insurance company up and ask them. They will tell you.

I'd say check with the insurance provider but it does sound promising IF you can prove WLS is medically necessary. My policy also required a determination of medical necessity so I had my PCP, pulmonologist, both orthopedic surgeons and my chiropractor write letters stating that the surgery was medically necessary and why. My surgeon submitted all 5 letters as supporting documentation and after 3 months, I was approved on the first try. Good luck! Vickie J.

Hi Fee, Just wanted to say hello - from a fellow OH member in Palm Bay! I am 2 months post op. Laura