INS. QUESTION

MY QUESTION IS ..... I HAVE INS AND WHEN I CALLED TO ASK ABOUT COVERAGE FOR WEIGHT LOSS SURGERY, THEY SAID THAT NOTHING WAS COVER FOR OBESITY, WEIGHT LOSS, OR ANYSURGERY. SO MY QUESTION IS HAS ANYONE ON HERE HAD THIS TO HAPPIEN TO THEM. SOMEONE WAS TELLING ME THAT THEY THOUGHT IF MY PCP SAID THAT IT WAS MED. NEEDED THEN THEY MAY PAY. IF YOU HAVE HAD ANYTHING LIKE THIS TO HAPPIEN TO YOU PLEASE HELP!

Personally, no it's not happened to me.  I did meet a lady in one of my nut. classes that said her ins. co said the same thing and she kept "fighting" it with letters and whatnot and they eventually agreed.  Talk with your family doc.'s insurance coordinator.  He/she might have ideas about  what to do.  Sometimes, those clauses in the policy are concrete and they won't budge, but it can't hurt to try.

Michelle

Some companies when they do the insurance policy they have what is called a weight loss surgery exclusion.

I would call back and get confirmation of this. If there is a weight loss surgery exclussion there is not much you can do until the company you work for or are covered under changes their contract with the insurance company.

Many companies do this so they won't have to pay for weight loss or surgery.

Do call back and ask to speak to a supervisor to get confirmation

Tamara

I was on Aetna as insurance and they said same thing. I had medicare as secondary and had to switch and make it primary to be covered. Worked great. A lot of insurance companies wont cover WLS

I have wls as an exclusion on my health insurance policy and have done a lot of research and am willing to share what information I have with anyone that needs/wants it .

Please understand that information is for you to use as needed or desired no gaurentee of getting anything approved.

1)  Find out what state governs your health insurance policy.
2) check with your state commision on insurance and see if there is staute on the books that requires health insurance to cover wls.
3) make sure that you read your policy completly and understand all of the terms.
4) you need to know if your policy is fully funded or privatley funded.
5) also find out what criteria your insurance company requires for approval , even if it listed as an exclusion.
6) You may want to check with your HR or benefits department and see if they can or will obtain a rider for the surgery to be covered.
( I have been to my benefits dpt and they are working on trying to get a rider)
Some employers do not really understand or realize what statistics are on obestiy and its long term effects on work production, increased long term treatment cost of co morbidities as well as time lost.

Prepair an appeal and be ready to fight, fight, fight for what you need.

I am gearing up for a fight and plan on wining come Hell or highwater.

I am going to do what I have to

Also I have case law that shows that no matter what state governs health insurance the laws of the state where the insured resides can not be ignored.

Feel free to contact me off line if you like and I will help any way I can [email protected]

never settle for less than you deserve and you desreve only the best.

Hugs

Lori
Baltimore

thanks to all of you for the info you have taken the time to tell me i have gone to our HR dept and they say they are already looking into including wls in our cover for the up coming year. again thanks