what do u think this means?

Hey yall im freaking out i called my insurance company and got a total different response telling me my plan did not cover wls.......this is how my benefit book reads...what do you all think...... General medical exclusions Treatment for obesity or services performed primarily for weight loss or control (including gastric bypass and gastric staplings); but this shall not exclude procedures that are necessary due to a specific condition caused by another illness or for morbid obesity as determined by the plan. Does anyone know what that means or have a insurance with similar wording...im freaking out ...the women at insurance company wouldnt explain it and just kept saying your plan doesnt cover it........who should i talk to....any help would be greatly appreciated......Sharon 

I belive this means you need to have comorbidity conditions, Hypertension, sleep apnea, diabetes BMI over?40.& arthritis. are some that come to mind. You will have to fight with them a bit but keep the faith .  Good Luck Taylor

thanks for responding...i hope thats all it is...i dont know why the insurance person just kept saying no its not covered......anyways thanxs

I think it means that your plan covers WLS treatment for morbid obesity but not for obesity or weight loss/control.   It would be a good idea to post your message in the Insurance Help board.  There are several regs who know their way around the insurance maze.

Thanks vicki i will try that next ...sharon

I got a similar response when i called my insurance company but when OHSU called them it was a different answer entirely-I dont think the insurance companies want to talk to us mere mortals. Whereas the doctors offices seem to have the right phone numbers and know the right things to say. Tina

I think your right Tina i called the corporate human resources benefit department and after several attempts to reach her she told me NO its not covered...so when i asked about why does its say this and that ...she asked me "well do you have a medical problem, are you seeing a doctor" can you believe that i felt like telling her it ws none of her business....so i told her yes and im in a program.....she said well ill have to look into it and call you back...so im hoping she calls back ...all of my stuff is done and now my chart is up for review for submittal to insurance...so one way or another ill get my answer................this is killing me its worse then waiting for all the other stuff.......Sharon

Your appeal should be based not on weight loss, but rather for the treatment of another illness such as diabetes.  This seems to be the way to get around that these days!

Trisha