Question:
Just wondering if anyone can clarify.....insurance rules for surgery

   — Jennifer A. (posted on October 5, 2003)

October 5, 2003
Which rules specifically are you interested in and for what insurance or just in general?
   — [Deactivated Member]

October 6, 2003
You have to be at least 100lbs overweight and it has to be medically necessary ie...acid reflex disease, high blood pressure, or diabetes. Some require documentation of previous diets that have you have tried. I also had to have a letter of recommendation from my primary care doctor. The first step is to go to a consultation with a WLS doctor. They can give you the paperwork you need to send to your insurance and will tell you what is required. Take care and God bless!!
   — laurab

October 6, 2003
Just to add more to this post...i have a strange policy that is making me anxious. my case is in review now. My policy book states that is you are MO than this is a covered expense. however, when I had my constult and called the insurance co (uhc) to check on it they said my specific policy says its 'excluded, unless life threatening'. My husbands job is self insured. we called them and they said it is covered as long as i met the critera. (husband called and forgot to ask WHICH CRITERIA. they just told him 100# overweight and problems associated with MO.) anyways, im just really anxious about this as I havent heard anything back from insurance.
   — Jennifer A.

October 6, 2003
Most insurance companies will not cover the surgery if you are just "Obese" with no co-morbitities. They usually require you to be "Obese with co-morbities" or they require you to be "Morbidly Obese" or "MO with co-morbidities". Many MO people have co-morbidities which could be concluded as "life threatening" ie: Sleep apnea, diabetes, circulation problems etc.
   — M B.

October 6, 2003
my co morbid's are mainly high bp, gerd, shortness of breath and dr suspects sleep apnea (im not haveing a sleep study UNITL i know for sure insur will approve me)
   — Jennifer A.