Please Help Me! I'm New

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

Have you tried calling your insurance company and asking if they would cover it? And also if they require any pre-reqs, like documented attempts at weight loss?

This is a difficult one when it's specifically excluded normally there is no way they will cover it.  However, that doesn't mean you shouldn't try.  Please call your insurance company and see what they say.  Also it's not just Obesity it's Morbid Obesity.  Mostly surgery is only covered for those that are Morbidly Obese.  That means the BMI has to be over 40.  Please call and let us know what they say.  Do you have a choice of insurance plans at work?  Maybe you can change to a different insurance when the time comes.  Also there is self pay to consider.  I never thought I would have got my surgery.  I worked for a company that had insurance that didn't cover it.  I got a new job and still had to go through hoops because Sleeve wasn't approved yet.  I had to take it all the way to my benefits admin for an exclusion.  It was a long process but believe me, this can happen for you :)