Insurance

Love this.  As all of you are probably very familiar with insurance, as I see many head to Mexico because our outstanding insurance coverage, my situation today will be very famlliar.  I am anxious to start my WL journey, and though I have insurance, I also have an obesity exclusion.  No biggie.  I thought I could find a loophole somewhere.  So I am considering having the sleeve procedure done, which I was delighted to find out my insurance WILL cover.  But here's the catch:  They will cover it and all costs as long as it's deemed a medically necessity due to anything other than weigh loss.  Hmmmmmm.  Could I say I have a giant worm that needs to be removed?  Or the surgeons were operating and "whoops, we accidentally gave her a VSG!  My bad."  Does anyone have anything similar that they have been able to work around or what code their surgeons have used besides the CPT 43770 and 43644? Muchas Gracias and Happy Cinco de Mayo!

LOL on the giant worm. I think acid reflux if its bad enough will qualify someone.  You could post this in the main board too, you might get more responses there.  Or go to a seminar, the surgeons are experienced with the ins companies and what will qualify you.  Good luck!

Each insurance company is different.... but usually the strictist insurance usually requires a BMI over 40, and 2 co-morbid conditions (high blood pressure,  diabetes, high cholesteriol, ) and history of being overweight for over 5 years. You could start with your PCP and see if that person says the surgery is medically necessary I just got coverage this year. Helen

Make sure you document everything, talk with your PCP. It may take some work but it will be worth the hassle. I know Dr. OH at St Francis in Federal Way and his staff are very good at working with the wounderful insurance people! Don't give up being healthy is so great! Merrilou