Question:
Do you see this as a Limitation or Exclusion.?

OH! Insurance companies STINK. My policy clearly says that all treatments of obesity which includes baratic surgery, gastric bypasses, balloons, stomach stapeling, laparoscopic banding, etc are not covered UNLESS authorized by the medical plan due to the existence of comorbidity. I got a real nice letter from my PCP that talks about all of my Comorbs which include GERD, High Blood Pressure, Chronic Backpain, Sleep Apnea, etc..... Today I receive a call that says it an exclusion in our policy. Well according to the way I read the policy it could possibly be a limitation but this is not excluded if I qualify under the "authorized by the medical plan due to existence of comorbidity". Wouldnt you say that I would qualify under this category according to the way this reads. Someone help!!! Are they jerking my chain and trying to get me to give up?????    — CARLA C. (posted on October 2, 2003)

October 2, 2003
They sound like they are jerking your chain and trying to get you to give up. They goofed by putting in that co-morbidity thing, and making it singular!! Somewhere in your policy MUST be a list of what they consider co-morbidities... you need to get that list and make sure you can document at least one of what they consider co-mordities in order to force them to authorize you. Make them send you the list in writing, too. Don't just take someone's word for it over the phone!! (That goes for denials, too...) Good Luck!
   — Sharon m. B.

October 2, 2003
In addition to what the previous poster said, if the policy says it's not covered for "treatment of obesity," NOT morbid obesity, you may be able to get around it, too. Good luck!
   — Leslie F.

October 2, 2003
My insurance had similiar limitations. The key is that it didn't talk about morbid obesity. Once my surgeon proved that I was MO with multiple comorbities, the insurance predetermination was immediately approved and the insurance company has covered everything so far. I would ask your insurance what is you coverage with a diagnosis code of morbid obesity.
   — rleffler

October 3, 2003
I am with Bob, your policy says that surgery is not allowed for "obesity" it does not mention Morbid Obesity. Best wishes -
   — M B.