Question:
Do HMO insurances cover WLS?

I just got off the phone with my insurance company and I asked if they had myletter from my family doc telling them why I need this surgery.the woman was sort of rude and said..."Most insurances don't cover this procedure" ugh...if I am reading all the posts correctly...this is an untrue statment correct? have a feeling this is gonna not be good for me :( plz feel free to email me if you want...thanks and god bless you all :)    — WIBlueyes (posted on April 25, 2001)

April 25, 2001
I think its 50/50 about half do and half don't. And of those that do cover it.. they may not cover it for all packages (employers) but will for some etc. Get a copy of your benefits and search for your limitations and exclusions piece. Email me with it and I'll see if I can help you.. I work in the insurance industry. Good luck...
   — Dawn R.

April 25, 2001
I have Aetna HMO and I was covered. I'd suggest looking at the insurers link on this site and selecting your state. It's quite possible that someone else has been approved/denied by your insurance carrier and can tell you what the criteria are.
   — PT LawMom

April 25, 2001
Kari, Bless you for havign the courage to look into this. Most people will hear no from their insurance agencies and stop, depressed and hopeless. However, as others have posted HMO's do cover them adn in some states it is Illegal for an insurance company not to cover you. They can deny you for petty reasons, but they have to cover it if you meet a set criteria. You are right, more and more insurances are covering this surgery because of long term effects... and reduced charges in the future =) So whoever you talked to there was WRONG, and was probably 110 lbs who'd never been overweight a day in her life.. =) Just liek the person in my insurance company who told me "Not to take this surgery so lightly, it could cause my death..." another ignorant person! Simply put to her "What part of 476 lbs am I taking lightly? Obesity is a definate death!" Good luck to you =)
   — Elizabeth D.

April 25, 2001
Yes, HMOs do cover this. I have Kaiser HMO and have been approved. Don't let some idiot in member services lie to you! Try to get their written policy on gastric surgery. Chances are you'll just have be deemed with a medical necessity and have your primary doctor write you a referral. Good luck to you!
   — careywatkins

April 25, 2001
It would be helpful if you include what type of WLS you were inquiring about. Some insurance companies WILL NOT cover the DS and LAP BAND because they say that they are experimental. Many HMOs cover the RNY. I had mine through Aetna with no problems.
   — Jeannet

April 26, 2001
Kari, I have Bluecross Californiacare HMO and was told it was covered if found medically necessary by my medical group. My medical group is then the one to give me approval which they did in a few short weeks. And also, with HMO I have zero deductibles/co-payments.....
   — Mandy M.