I need help, P.S.E.W insurance question new to site
Hi I am looking into getting the operations, I am 6 ft and weight is 313 ,have hypertension.
Have 2 young girls, 3 1/2 and 2 years and would love to shed some pounds to live longer and keep up them them, anyways after my 2nd child I went to a endocrinologist (sp?) and he said" you wont lose weight weight and if you do you will gain it back, you have a "fat " gene and your body want to store fat, the only thing that will work for you is bypass" after I dried my tears , I said no!!! hes wrong!! well 2 years later here I am , still fat and I think he might be right, SO
finally my question......... I read in my insurance booklet , they say they do not cover any weight loss procedures .
but if I had a dr say I really needed it because my BFI is 42 and I have high blood pre. and nasty huge varicose veins would they approve, or would I be wasting my time?
my insurance is a odd one its my husbands its Puget Sound Electric Workers welfare and trust under that its says First Choice Health ,networking
any help would be great thanks!
It's all in the wording & how strong their exclusions are . My policy says Exclusions - weight loss surgery despite any & all co-morbidities . Regardless of severity . That is not it word for word , but they will not cover it at all no matter what . I even asked my surgeon's office & they said Uniform does not cover WLS period . It sucks . So you basically have yours & then your husbands to fall back on ? am I correct ? Read it carefully . Many of them will pay if you have certain comorbidities . Some will deny you the first time & then okay it , if you follow their guidelines . You usually have to either prove you've been on a supervised WL plan for a certain time , or you have to do that & then they will okay it . If you can view it online (your policy) , copy & paste it & maybe we can help more . When in doubt call them . Kathy
Monica,
I have teamsters welfare trust and it is also First Choice. They have an exclusion on weight loss surgeries. I ended up self paying. The doctor you choose to go to knows all the ins and outs of the various insurance companies and they can help you a lot with that.
My insurance did cover all the preop testing because it was not coded as obesity related.
I paid 12800 for my lap band, a friend went to Mexico and paid 8500. If you are going RNY then it will be more of course.
Good Luck,
Donna C