Hi there..
Welcome and howdy!
HW: 475, Consult WT: 450.5 **Lost 63 lbs pre-op** SW: 387.5 M1: -31, M2:
Check out my blog about my journey so far: http://breakingoutbebe.blogspot.com
Hi, I'm new also trying to start my journey with you and everyone just having a hard time right now. Heres part of my story...
Post Date: 9/5/12 8:38 pm
Hi All! My name is Jodi I am morbidly obese and have a letter stating surgery is life threatening and is a medical nessesity. I have Anthem HealthKeepers With NO Rider/ Exclusion. It states
OBESITY: Services and supplies related to weight loss of dietary control, including complications that directly result from such surgeries and / or procedures. This includes weight loss reduction therapies / activities, even if there is a related medical problem. Notwithstanding provisions of other exclusions involving cosmedic surgery to the contrary, services tendered to improve appearence (such as abdominoplasties, panniculectomies, and lipectomies), are not covered services even though the services may be required to correct deformity after a previous therapeutic process involving Gastric Bypass Surgery.
I have sleep apnea
High Blood pressure
Stents in my heart
uncontrolabl diabetes
edema
depression
p.a.d
Sciatica
dyspnea
very high cholestrol
BMI is 51
and a few more issues
My question is does anyone understand this policy and can i get my insurance comp. to pay for my surgery? PLEASE help me. I want to live... Thank you so much in advance
Post Date: 9/5/12 8:38 pm
Hi All! My name is Jodi I am morbidly obese and have a letter stating surgery is life threatening and is a medical nessesity. I have Anthem HealthKeepers With NO Rider/ Exclusion. It states
OBESITY: Services and supplies related to weight loss of dietary control, including complications that directly result from such surgeries and / or procedures. This includes weight loss reduction therapies / activities, even if there is a related medical problem. Notwithstanding provisions of other exclusions involving cosmedic surgery to the contrary, services tendered to improve appearence (such as abdominoplasties, panniculectomies, and lipectomies), are not covered services even though the services may be required to correct deformity after a previous therapeutic process involving Gastric Bypass Surgery.
I have sleep apnea
High Blood pressure
Stents in my heart
uncontrolabl diabetes
edema
depression
p.a.d
Sciatica
dyspnea
very high cholestrol
BMI is 51
and a few more issues
My question is does anyone understand this policy and can i get my insurance comp. to pay for my surgery? PLEASE help me. I want to live... Thank you so much in advance
Hi Jodi,
Welcome.
Are you saying your insurance company has an exclusion for WLS because your condition was noted as obese only? I'm sorry I'm confused . If your plan does not have a formal exclusion in the Certificate of Insurance, then you can appeal any denials for the surgery. This can take time and I strongly advise you to send all appeals certified mail to the address stated on the benefit summary you received that had the denial. I also would copy the Department of Insurance in your state.
If your plan does have a formal exclusion for treatment of WLS can you afford to pay yourself? You can get special medical loans for surgery as well.
Good Luck,
Sharon
Welcome.
Are you saying your insurance company has an exclusion for WLS because your condition was noted as obese only? I'm sorry I'm confused . If your plan does not have a formal exclusion in the Certificate of Insurance, then you can appeal any denials for the surgery. This can take time and I strongly advise you to send all appeals certified mail to the address stated on the benefit summary you received that had the denial. I also would copy the Department of Insurance in your state.
If your plan does have a formal exclusion for treatment of WLS can you afford to pay yourself? You can get special medical loans for surgery as well.
Good Luck,
Sharon
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