Help!! Medcost question. . .

Donna B.
on 1/11/07 6:35 am - Somewhere in, VA

Hello everyone.  I have Medcost Preferred and when I contacted my carrier to ask about WLS, I was told that the only requirement was a BMI over 40 and that it be medically necessary.  I looked up my policy on line and all it said was that Gastric Bypass is covered as a regular benefit.  I also called the customer service number on my insurance card and the lady in the benefits department there told me the same thing.  That's all the info I could find regarding my policy. I have talked to a couple of people who have had the RNY who had Medcost and both of them said that they had to have a 6 month documented diet record (ex: Weigh****chers, Jenny Craig, etc) before they could get approval.  One of the people I talked to didn't know this until all her info had been submitted to insurance and they denied her.  I'm not sure about the other lady.  Now, I know that all policies are different but I was wondering if anyone could tell me if they had to do this too even though nothing was mentioned about it in their policy?     Thanks! Donna F.  :-)

JayB
on 1/12/07 12:54 am - Inwood, NY
Hello, I am not familiar with your insurance but did you pick a surgeon yet? Because the surgeons office should know what your insurance is going to require.  As long as they participate with your plan their office should have some experience with what is required.  Its always better to be safe than sorry! GOOD LUCK!!
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