Question:
I contacted my insurance provider and they told me that WLS was not covered. What sho

   — William L. (posted on August 24, 2005)

August 24, 2005
What should you do now? Is that what you are asking? Well, some people will take out a home equity loan or sometimes a short term loan. Or sometimes mortgage your house. Some people get others to loan them money.
   — ChristineB

August 24, 2005
First go to the exclusions section of your benefit booklet and see exactly what it says related to weight loss/control. Unless it clearly says that WLS is not covered in any situation, go ahead and have the surgeon submit the pre-auth. Many time the customer service reps are told to not be helpful and they won't tell you that in certain situations it can be approved. You have nothing to lose to submit and then even appeal. All it costs you is some time and effort. If it still is denied then you need to look at what financial options you have. Good Luck!
   — zoedogcbr

August 24, 2005
The insurance company csr's are trained to say no. You may want to talk to a doctor, determine if the surgery is right for you based on your weight loss attempts, BMI, and general health. If you can get your doctor on your side, the insurance company may start to listen. Good luck, William - this website is a great resource!
   — gidget

August 24, 2005
William, it's not that the phone reps are trained to say no, it's that they are not educated on how to look up specific policy coverages. If they were, they would be a)thouroughly confused, and b) more likely to give out false information. CSR's are usually given a 'general' policy to quote from and typically those will not state that WLS is a covered benefit.<br><br>The best thing you can do is look at your specific policy where the exclusions are listed, this will give you a better idea of your specific coverages. And unless it is blantantly obvious that your policy doesn't cover the surgery, go for it anyway. UHC told my surgeon it wasn't a covered benefit of my policy and at the time I worked there, knew my policy quite well, and also knew the restriction of information given to the CSR's. Good luck to you.
   — RebeccaP