I really need some help I have 5 years of trying to get this weight off, now I have high blood pressure, and Molina wants me to have 12 months of seeing my doctor and I have 5 yrs but it has to be 12 months and you have to go each month. Why does Molina in some other states only a 6 month visit with your doctor?

I think it just depends on what requirements are written into your health care plan. It seems like the insurance company decides, but your employer controls some of the requirements based on what kind of plan they select for their employees. So even though I'm sure there are many surgeons who will do surgery if you're under 21, you're kind of at the mercy of the requirements of your own specific insurance plan.

Based on what I have learned in my insurance quest, once thing**** the independent review process, you're evaluated on the basis of medical necessity, not insurance coverage. My recommendation is to invest the time in talking to someone experienced in the area and see what they say. From what I understand, it's a tough road to go, but I think some people have overcome their exclusions.

Hello,

Anyone ever fight a written exclusion to cover WLS? It is not and employer based exclusion just a general policy one.

Is it even worth fighting it? Could it be appealed and over turned with enough proof of medical necessity?

Thanks in advance.

I have heard of these fees but thankfully my surgeons office only charges $500 and they do bill insurance for it. If insurance will not cover it, then it is my responsibility.



You should see if you can make payments or if you are not set on that surgeon, see if there is another in your area who works better. Not all offices charge that high of a program fee.