I have HCH Administration Inc.

HCH Administration OSF HealthPlans (Dan Network)through CEFCU. I think this would be considered a group policy. I'm not sure. It has a exclusion for all weightloss. Unless it is deemed medically nescessary. I'm 5'4", weigh 303 lbs. and have acid reflux (self-diagnosed), my feet swell when I recline, my back aches (DDD boobs), I cannot bend my knees, I think I may have PCOS and I am concerned that I may have Diabetes. I have documented tail bone pain. I have tried and failed at many diets, I would lose a couple pounds and put it back on plus more. I will be making an appointment with a PCP this week, I don't currently have one. With all that I have what are my chances that it would be deemed medically necessary?

Diva:

Welcome to the board, (if your new). First of all find a PCP, Get a complete physical and let them make the official diagnosis.  But from what information you have listed, if it is is confirmed
then most likely wls will be deemed medically necassary. 
A piece of advice though.  Make sure you read your health insurnace policy about what is convered and what is excluded.  Make sure you
know what state you policy is goverened by.

(example:  I live in MD but my health insurance is goverened by the state of California; Because that is where it is written.)


Good luck and keep us posted to your progress and post any other questions, comments you may have.


Hugs from Baltimore

Lori

 

Never settle for less than you deserve and you deserve the best.

Any weight loss surgery or weight related services are excluded unless deemed medically necessary. So I think I am going to have a fight on my hands.