I don't know anything about insurance...

Sunshine Will Be
Skinny !

on 7/11/09 6:51 pm
VSG on 02/14/11 with
but my insurance used to say that Weight Loss Surgery or any Weightloss Diets are excluded unless found Medically Necessary. Now there is no mention at all if it is covered or not covered. What does that mean? I know yall don't have a crystal ball and can't really read into. Just wanting to know if anyone else was able to get approval with it not being confirmed or denyed in the wording of the insurance forms.

Follow my Journey on YouTube: http://www.youtube.com/user/SunshineWillBeSkinny
and my Blog:
http://www.sunshinewillbeskinny.blogspot.com
 I am 5'5"
    

        
Vicki Browning
on 7/12/09 6:06 am - IN
Try looking under exclusions to see if it is contained in that part it should have something about it there I would think thats were they usually embed them
Sunshine Will Be
Skinny !

on 7/13/09 2:31 pm
VSG on 02/14/11 with
Ok,
I found my original policy binder. It unfortunatly states treatment of obesity is excluded. However this policy book was printed up in 2004. I contacted them at one point last year and was told that if it was deemed medically neccesary than it could be covered. I emailed them a few days ago and I got the response that it is excluded. So is my only other option Self-Pay? Or is this something that I could fight and win?

Follow my Journey on YouTube: http://www.youtube.com/user/SunshineWillBeSkinny
and my Blog:
http://www.sunshinewillbeskinny.blogspot.com
 I am 5'5"
    

        
Vicki Browning
on 7/13/09 10:30 pm - IN
 here is Obesitylaw.com website for FAQ's and questions and answers about exclusions

http://www.obesitylaw.com/faq.php
skinnydesires
on 7/21/09 3:35 am

What I would do is have them fax or mail you any exclusions you may have for WLS.  I couldnt find the info in my policy and I kept getting different answers everytime I would call in so I just made them send the info to me so that I can review it for myself.  Dont accept their answer until you have proof in your hands.

Most of the people on the phone told me it wasnt covered.  The paper they faxed me said it wasnt covered UNLESS it was medically necessary with a BMI of 40.  My doctor submitted it for approval and they denied it saying it wasnt covered.  I fought it and won my appeal because it really was covered.  I think many insurances dont want to pay and hope you wont fight for it.

Dont give up quite yet   Good luck!

~*~Debbie~*~

    
ClareB
on 7/22/09 5:42 am - MA
Sounds like it is covered...you just need to force their hand.  Post this on the board...ask if anyone has your exact insurance...(BCBS of Pennsylvania example)  Did they cover it...because once they cover it they have to cover everyone...DO NOT TAKE THEIR WORD FOR IT...they will do anything to keep from payinf for any procedure whether it be a WLS or an XRAY...Do research and submit with the surgeon for a prior approval and take it from there.
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