Question on Pacificare HMO insurance/ State

jgtaxi
on 11/9/08 2:46 am, edited 11/9/08 2:47 am - midwest city, OK
Help!!

Does anyone know if the Pacificare HMO insurance with State and Education Employees covers any of the weight loss surgeries? 
I'm looking into the Laproscopic Sleeve and am wondering if they cover it or if all weight surgeries are excluded.  Hopefully someone on here has dealt with this insurance company.
Thanks for you help.    judy
Happycat
on 11/9/08 4:25 am - Midwest City, OK
OSEEGIB has an exclusion for any treatment relating to obesity.  I ended up being self pay due to their short sightedness.  I even spoke in front of the products board explaining that they did indeed cover obesity- the health problems associated with obesity such as heart attack, stroke, diabetes, etc while offering no coverage for the treatment of the disease itself.  I personally think they are a bunch of short sighted dweebs!  OK, crawling off soap box!
I have maintained for one year at this point.  I am steady at -120 pounds.  =)
40 pounds lost pre-op    
My_Name_is_Earl
on 11/9/08 4:34 pm
I've had the same experience, but I'll take it a step further.  If you have a medical savings account, OSEEGIB won't even let you use those funds (which you've set aside without any governmental contribution) for weight loss surgeries or anything else weight loss related.
fleemore1
on 11/9/08 9:53 pm - Harrah, OK
I can't believe they wouldn't even allow you to use your medical savings account for this.  We have an account where I work through AFLAC and my DH has one through his school only they use Ameridan Fidelity.  Mine paid out MY funds immediately but I had to submit a letter of necessity to American Fidelity (guess they thought needing to loose 200+ pounds was simply cosmetic!!!).  Anyway, both funds paid out what we had in them but still didn't come close to the $15,00 out of pocket.  I'd doe it again though...I'd find a way to self-pay...which I did.  The best decision of my life.

This is the ride of my life.....what an amazing tool I now have!!!
Carrie C.
on 11/9/08 11:13 pm - Harrah, OK
Sorry I am a state worker also. I am self pay. I have the Pacificare insurance and it is EXCLUDED. I did get the band and fills are covered. They did not exclude after care. hehehe
Also nut visits are covered. The Dr visits are to. I go to weight wise. Everything but the actual surgery is covered.
Carrie  Banded 3/19/2008              H276/S222/C168/G140
 

http://www.TickerFactory.com/weight-loss/wIU59aJ/
jgtaxi
on 11/10/08 5:38 am - midwest city, OK
Did you have to get a referral for the dr visits ?  How about  the sleep apnea test if it is needed?  Is it covered?  
Looks like I will have to be a self pay then also but if some of the other expenses are covered that would help.    Thanks.  judy
Happycat
on 11/10/08 10:17 am - Midwest City, OK
I have Healthchoice.  They did pay for the pre-op testing- excluding the nutritionist and exercise physiologist.  I paid out of pocket for those too.  I had already had a sleep study that insurance did pay for- as well as the CPAP I needed.
I have maintained for one year at this point.  I am steady at -120 pounds.  =)
40 pounds lost pre-op    
jgtaxi
on 11/10/08 10:27 am - midwest city, OK
Well I'm hoping that I can get them to pay those things too.  I'm going to check with my Primary Pysician and see if he will refer me to have the sleep test if needed. 
Every little bit will help. 

I think it is a shame that they write it out of the policies for as much as we pay for insurance these days.  
It would illinate alot of other expenses for them if they did allow these surgeries.  But I guess they don't listen to us.  

Thanks for your information.
I'm going to my first dr. visit tomorrow.  I'm off on the first step. 
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