Sue G.
Smoochies
ARlies 
Yea girl, I am fine, thanks for asking. Just stressed out a bit over this dang waiting for insurance approval. It's been 3 weeks. I finally got a letter today and it is almost like a "non letter" doesn't say yes - doesn't say no.
Everybody, what is your take on this? I have faxed it to Liv Lite and hopefully they can make more sense of it.
Dear Susan:
We are in receipt of your letter regarding the request for benefits for gastric bypass for the above named person. Pre-certification may be required since this is an inpatient procedure. Please contact your Customer Service Department for any contract requirements.
To assist with the determination of whether this will be a covered benefit, the criteria used for the member's contract is as follows:
1. Member must have a BMI of 40 Kg/m2 or higher.
2. BMI of greater than 35 Kg/m2 in conjunction with severe comorbidities. An example of sever comorbidity is cardiopulmonary complications or sever diabetes.
3. Whether a member's BMI is 40 or 35 with comorbids, the member must have achieved full growth, have no specific treatable correctable cause for the morbid obesity (e.g. endocrine disorder) and have failed conservative treatment measures.
If you have further questions, please call the Customer Service telephone number apprearing on your membership card.
NOW TELL ME... What the hell does all that gobbledy goop mean????
Sue
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