Question:
How do I get my insurance to pay?

Is there any way I can get this gastric bypass surgery for other than obesity? There is a claus in my benefits that excludes any services or supplies provided for reduction of ovesity or weight, including surgical procedures, even if the participant has other health conditions which might be helped by a reduction of obesity or weight. Is there some way I can get the insurance to pay for the surgery without knowing it is for weight loss? The insurance I have is BCBS of Texas. It is a PPO. I really need some help!    — T. H. (posted on March 1, 2001)

March 1, 2001
I would not ask a doctor to commit insurance fraud and I would not use a doctor who would want to commit insurance fraud.
   — [Anonymous]

March 1, 2001
One item to check out is the fact that your policy excludes coverage for the treatment of 'obesity.' Just so you know, most do. But, what they DO cover is surgical treatment for 'morbid obesity' this is different than simple 'obesity.' It sometimes comes down to asking the right question - EXACTLY the right question. I have BCBS of ND and it is a PPO and I was covered, no problem. Have you checked out your insurance company on the obesityhelp.com website? If not, please do -- perhaps it has covered the surgery for others. If you don't know how to check on this, let me know. P.S. Are you related to any Hochstetlers in North Dakota?
   — Cindy H.

March 1, 2001
My insurance had a similar clause...the difference is MORBID obesity and MEDICAL necessity. Ask if they cover gastric bypass when medically necessary - most companies should cover it under those circumstances or they are discriminating against you.
   — Lisa B.