Question:
Complications from old surgery, new insurance has exclusion.

Hello, I had RNY about 6years ago. All was fine. A couple of months ago, I began having severe, severe, severe pain about an hour after eating. It was so bad...it got me back to my old doctor. They did an endoscopy and found that I have a 'jejunal diverticulum" (spelling is bad) off the pouch. I need to have it cut off because of 1. pain and 2. risk of perforation. the surgeon showed me the pics and it was quite impressive/disgusting. My current insurance (aetna) has an exclusion policy for morbid obesity surgery. Anyone w/ experience in this area: will they cover a medically needed correction to a complication caused by obesity surgery? Anyone else out there heard of this complication. I can tell you one thing...it really, really, hurts.    — smithjl (posted on April 26, 2009)

April 27, 2009
Hi, Most insurance companies do state they have an exclusion to weight lose surgery for morbidly obese people. I believe that is mostly for say, tummy tuck, lipo. (cosmetic) But we all get around the exclusion because the exclusion also states unless the surgery is deemed medically necessary by your doctor. If it causes a health risk to you, then it is necessary. Best Wishes. Have your doctor submit it and if they deny it time again; keep filing a grievance. You will eventually get it. Best Wishes.
   — Kristy