Need help understanding insurance...

Lagniappe12
on 6/15/06 1:03 pm - Atlanta, GA
Hi, I just got back from a support group for WLS which inspired me to make 110% sure that I was reading this clearly (clear exclusion) and that if there was a tiny loophole, I could take advantage of it. Here is what it says in my booklet.: "Any services or supplies for the treatment of obesity, including but not limited to, weight reduction, medical care or Prescription Drugs, or dietary control (except as related to covered nutritional counseling). Nutritional supplements; services, supplies and/or nutritional sustenance products (food) related to enteral feeding except when it is the sole means of nutrition. Food supplements. Services for Inpatient treatment of bulimia, anorexia or other eating disorders which consist primarily of behavior modification, diet and weight monitoring and education. Any services or supplies that involve weight reduction as the main method of treatment, including medical, psychiatric care or counseling. Weight loss programs, nutritional supplements, appetite suppressants, and supplies of a similar nature. Excluded procedures include but are not limited to bariatric services, bariatric surgery (e. g., gastric bypass or vertically banded gastroplasty, liposuction, gastric balloons, jejunal bypasses, and wiring of the jaw)." I know it's a pretty strong exclusion however it doesn't say anything about medical necessity. Is this exclusinn too strong to get an exception? Am I completely shut down? Thanks (keeping my fingers crossed)!
megsm
on 6/18/06 2:08 am - Hempstead, NY
chech the state laws at obesitylawyers.com
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