Question:
Condition that causes weight gain?

My insurance (Blue Cross/Blue Shield) at first said they covered surger if medically necessary. Now after first denial they are saying that they only cover if I have a condition that causes the weight gain. Has anybody ever heard of such a policy?    — SJP (posted on March 3, 2003)

March 3, 2003
Are you sure they aren't asking for Co-Morbidities? Many insurance companies will cover the WLS if you have a BMI over 35 with one or more co-morbities (obstructive sleep apnea, hypertension, diabetes, heart disease, etc.) If I were you, I'd get a copy of the policy and read it for yourself and if you're still unsure, discuss it with your PCP.
   — Carolyn M.

March 3, 2003
I think too that they must want co-morbidties. I have BC/BS PPO. They want to know all your health conditions. You need to go back and find out exactly what they want . Good Luck!
   — Debbie W.

March 3, 2003
I also have BC/BS (PPO) and was approved after my first consult. My only advice is to ask specific questions and, when you hear a bunch of insurance baloney, ask again! I found that when I included examples to explain my questions, I got a much more specific answer. Don't give up!
   — Jodie P.

March 3, 2003
I agree, ask questions and find out what they want, specifically. Insurance companies (more than anyone) should know better, my goodness if there was an actual "known cause" there would be alot of rich people out there selling us the "FIX" I wish you all the best, you probably just need to be more specific on a question or two.
   — Dana B.

March 3, 2003
Thanks for the responses. BCBS came back with that answer after getting a letter of medical necessity from my surgeon. This letter included co-mobidies and BMI (46.9) I've also been trying to get a copy of the exact wording but for some reason they keep telling me that my company has this. When I asked my HR dept they just quote what BCBS has about "obesity" but not morbid obesity. I just sent for a copy of the whole policy from BCBS. The whole thing seems a little suspicious. Almost like some secretary called my surgeon and gave some excuse.
   — SJP