Things seem to be going good!

Hey everybody! I know I don't post much, but I always read all the other posts. Here's the scoop: When I called the insurance co. to ask if WLS is covered under my policy, the rep told me it was, as long as deemed medically necessary. I'm a little anxious (lol, that's the understatement of the year), so I also requested a breakdown of my benefits in writing. Now, I don't want to jinx myself, but this is what it says in my benefits/exclusions : "The group contract will contain standard benefit exclusions and limitations. As examples, except as specifically set forth in the group contract, no benefits may be provided for services, supplies or charges : For treatment of obesity, except for surgical treatment of morbid obesity." So, am I reading this right? Does this mean that WLS is covered as a benefit??!! I mean, that's what the ins. rep told me, but I still worry. My husband and I both read it and that's what we think it says, but I'd like some other opinions. I sure as heck hope so, because that's one less obstacle to clear!!

It does sound like WLS surgery is covered under your policy, however, it is now up to you and your doctor to prove to the insurance company that the procedure is medically necessary. Meaning, you need to show a history of past weight loss attempts, and any medical issues you are having due to your weight. I know some people have said their doctors like to go back at least 5 years for a "diet" history. I went back about 15 which I think was key in my approval. You also have to have a BMI which is 40 or higher OR a BMI of 35 with Co-morbidities.. (ie. high blood pressure, joint, back pain, shortness of breathe, sleep apena, diabetes etc..) Any medical condition which is worsened or brought on by your excess weight. The doctor, I believe, is key in this process because he/she has to be able to write a proposal in your favor which makes the insurance company see this surgery is a good fit for you, as well as in their own best interest... After all if they can pay for this surgery and prevent you from being on expensive medications and going to doctor after doctor.. they are going to take the cheap way out and pay for the surgery. My best advice is to make sure you are completely through with your doctor, don't leave anything out and have faith. Good luck to you!!!

Katie, Good Luck on your upcoming surgery (thats my bday)!!!!

From the way I read it, it says that it covers WLS for people who are morbidly obese which is 40 or above. I snooped and checked out your profile and calculated yours as 41.something so it looks like your good. Like in the other post make sure to be honest w/ your surgeon and list all medical issues you are having even if you think they are not related to obesity. EX: my surgeon gave me a small list of co-morbs and stress incontinance (pee when you cough or laugh) was on it. I had been experiencing it and had my surgeon put it on file. I had never heard of the term and diddnt know that it was due to weight! Anyways make a list of all the health problems you are having and make sure to turn them in to your surgeon, any little bit helps your case.