how do I begin? insurance question?

I am just starting to research the WLS subject and so far have limited myself to the internet. My BMI is 38 with no life-threatening co-morbs and I am 33 yo. My question is this: how do I find out if my insurance covers WLS? Can I just call them up to see if it is covered in our policy or do I have to apply through a doctor first and see what they say? I am afraid to go through the process and get my hopes up in fear that my insurance does not cover it or my BMI is not high enough. I am not able to self-pay either. We currently have PRM insurance (Professional Risk Management) - has anyone had any luck with them?

Kristen, I would contact your insurance company and ask them what they require for WLS. Also ask if there is a cap. Some policies will cover up to say $10,000.00 and you have to pay the rest. Every company is different as to what they require. I have Medical Mutual and there are at least 6 different plans that I know of and they all may require something different. Sometimes it is up to your employer if they put limitations or exclusions on your policy Hope this helps a little! Sue

Kristen, If your BMI is 38, unless you have diabetes, hypertension, sleep apnea, or severe arthritis, your unlikely to get approved through any insurance. If your BMI is above 40, many times you can get approval. I would recommend if you have any signs/symptoms of sleep apnea, you get tested for that. Good luck, Dr. C The Deaconess Surgical Weight Loss Center Cincinnati, Ohio (513) 559-2545