What are the chances for approval?

I have BCBS fo TX. In my benefits booklet under Limitations & Exclusions it states the following: (The benedits as described in this Benefits Booklet are NOT available for): 1. Any services or supplies which are not Medically Necessary and essential to the diagnosis or direct care and treatment of a sickness, injury, condition, disease, or bodily malfunction; or any Experimental/Investigational services and supplies. ....blah, blah, blah....... (Clause #24) 24. Any services or supplies provided for reduction of obesity or weight, including surgical procedures, even if the Participant has other health conditions which might be helped by a reduction of obesity or weight. I think "Medical Necessity" and the fact that "Morbid" obesity is NOT specifically stated are key factors in approval. What do y'all think? Does anyone have a similar Exclusion? Has anyone beaten an Exclusion like this before? At my place of employment, BCBS is the only insurance offered. We have a choice of HMO and PPO. I have the PPO. What do I do? I really want this surgery. I have an appt. set for consultation but can not get in to see the dr until Feb.14, 2001.

We greatly appreciate your interest in helping us build our Q&A database. To discourage vandals from posting garbage, however, we require people to register before posting.

You must be logged in to post an answer. Click here to log in.