INSURANCE HELP!!

http://www.anthem.com/medicalguidelines/va/f5/s10/t2/pw_
 Hello everyone ,I need some help with my insurance to figure out if weight loss surgery would be covered.
I have Anthem Blue Cross Blue shield of Virginia a PPO plan ,in my policy there is a written exclusion for obesity and states as follows:

Your coverage does not include benefits for care of obesity or services related to weight loss or dietary control ,including complications that directly result from such surgeries and or /procedures . This includes weight reduction therapies / activities , even if there is a related medical problem .Notwithstanding provisions of other exclusions involving cosmetic surgery to the contrary , services rendered to improve appearance are not covered services even though the service may be required to correct deformities after a previous therapeutic process involving gastric bypass surgery.

I know that it doesn't sound like it covers it but my benefit book was printed in 06,and on the Anthem website I came across a revision:  the link is at the top of the post
,in short it is revised in 2008 on weight loss surgery for morbid obesity that it is medically necessary if you meet the national institute of health guidelines .
does that mean that the policy should cover it if I meet the guideline and there is a difference in obesity and morbid obesity or am I just out of luck ,it is really important to me as I have no way to self pay but I would like to see about obtaining another insurance policy that does cover it,any help would be so very appreciated!

Yes, there is a difference in obesity and morbid obesity.

The information you found online with the update sounds like they may cover WLS if you can prove medical necessity.  BUT is this Anthem BC/BS's policy OR YOUR EMPLOYERS POLICY?  Anthem BC/BS may cover WLS but your employer did not necessarily choose to pay for that coverage.  You need a new benefits book from your employer.

Good luck!

TS

Hello-
It does sound as if you are covered based on the website update. But you should call the 'benefits' or 'customer service' number on the back of your insurance card to see what the benefits are for your specific policy. The last person to post is correct, your employer can decide to EXCLUDE weight loss surgery from your benefits, so you need to check. When you call tell them that you checking to see if weight loss surgery is 'covered benefit' under your plan. They may ask for the codes of the procedures and if they do, here they are: Adjustable Gastric Banding (Lap-band or Realize Band)  is 43770 and the code for laparoscopic roux-en-Y gastric bypass is 43644.

If it is a covered benefit, they will tell you that it has to proven medically necessary and you have to meet the National Institutes of Health Guidelines - this usually means that you have to have a BMI of 40 or higher or a BMI of 35 with documented proof of co-morbid conditions (ex: diabetes, high blood pressure, high cholesterol, sleep apnea, etc.). Then they may require additional things as well as every plan is different, so make sure you ask what criteria you have to meet.

Let me know if you need any help and good luck!
Billie