Question:
My Insurance company has told me there is an exclusion for obesity

treatment of obesity on my policy.I have spoken w/three different people at Ins.company and each have told me something different.One told me,if the surgery is not for "obesity" it may be covered.Another told me there was no way the Gastric Bypass would be covered.And yet another told me that all I would need was a "letter of determination" from my Dr....Help!!    — Mary T. (posted on August 5, 2004)

August 5, 2004
Hi Mary, Doesn't insurance totally stink? One of those love it or hate it kind of things. Probably the best route to go is to check out a couple of things. First, go to http://www.obesityhelp.com/morbidobesity/insurers.phtml and find your state, then scroll down and see if anyone else with your exact coverage has had approval recently. (It helps is you can find the employer that the insurance is offered through as a common denominator, as well.) Another thing to do is to call the surgeon you're interested in seeing, and ask their insurance person in the office if they have experience with your particular coverage. I can totally feel your pain, girlfriend. I went through the same thing. Our exclusion is air-tight, so I ended up being a self-pay patient. I went to Spain for my BPD/DS surgery - gosh, two years ago now - and am so thankful that my insurance DIDN'T cover, or that would never have been the path I took! I love my surgery, I love my surgeon, I love my life! Let me know if I can help at all, okay? Blessings, dina
   — Dina McBride

August 5, 2004
Mary, Sometimes its a matter of asking the right questions. Even after my Doctor sent in to see if my insurance would cover and they told them yes they do . They kept trying to tell me on the phone that my insurance doesnt cover weight loss surgery. Here is the deal. They will read you what it says in your insurance book word for word but sometimes they leave the end off. Usually an insurance says that weight loss surgery is excluded EXCEPT WHEN DEEMED MEDICALLY NECESSARY PER A M.D. That last part is the part they usually leave out. You just have to do research and dont give up on the fact that your insurance won't cover. Fight it all the way. Good luck. Jen:)
   — imgabbie

August 5, 2004
Mary, what ins do you have I have united health with a written exclusion and I was approved in 2 weeks... my center called them direct and it was not the ins co it was my hubby's job that added the exclusion... well things can happen because I was approved. good luck to you
   — Brandi A.

August 9, 2004
This exact thing has happened to me...if you get any good advice please forward to me...I have United Healthcare EPO THanks for listening...God Bless
   — ThankYouGod