WElllllllllll....
cuz its a pain in my butt? they say its a exclusion when this is all it says for exclusions:
Exclusions
Non-emergency Health Care Services that are not provided, ordered, prescribed, or authorized by a Group Physician or Referral Physician.
Cosmetic and reconstructive procedures undertaken to improve or modify a member's appearance, except for mastectomy reconstruction following breast cancer surgery.
Custodial or domiciliary care.
Artificial aids, corrective appliances, and medical supplies, except to the extent items shall be specifically listed as covered.
Services or supplies which are provided by an employer or governmental agency or entity.
Elective abortions, which are not necessary to preserve the health of the Member.
Experimental health care procedures.
In-vitro fertilization therapies or reversal of voluntary surgically-induced sterility.
Personal or comfort items during inpatient hospitalization.
Physical examinations and reports for employment, licenses, or insurance.
Psychological or other testing for educational purposes or services for non-medically necessary special education and developmental programs.
Cost of services in excess of the usual, customary, and reasonable charges.
In cases involving non-emergent treatments performed or prescribed by non-Health Plan providers, either inside or outside of the Service Area, and for which Health Plan has not authorized a referral, Health Plan will not cover any expenses associated with such treatments. In no event shall Health Plan cover any treatments which are excluded from coverage under this agreement.
Services for sex change operations or any related services.
Services covered under Worker's Compensation.
Experimental organ transplants and artificial organs.
Eyeglasses, contact lenses and any fitting charges.
Routine dental care.
yeah let the clinic fight it for you that what I did with my insurance. If you have any past documentation like family physicians, chiropractor, etc... that you discussed about your weight and issues regarding your weight let your surgeon's office know cause that can help sway the insurance company sometimes. Hell mine was that I went to go see an acupuncturist to help with weightloss.
If you are getting an individual PPO plan that's makes you the scriber (spelling) make sure that you disclose all prior health problems. Example... Back in 1999 I got an individual PPO plan Blue Shield disclosed most but once they found out I was trying to get weight loss surgery they retroactively dropped me from the insurance saying that I did not disclose all information causing me to pay for the sleep test, blood test etc... and no surgery. Not saying that will happen with you but just letting you know.