Question:
how can an insurance determine whats medically necessary?

I called my insurance and said there is a exclusion in my policy, that if my weight is life threatening then the surgery could be approved.    — [Anonymous] (posted on April 22, 2001)

April 22, 2001
When I initially called my insurance company, they said that ANYTHING weight-loss related was specifically excluded from my policy. I didn't take that as an answer. I went through with my appointment with the surgeon, let them do what they do best, and the insurance approval came after the first request from my surgeon's office. There are specific test results that the insurance companies need to see, they have doctors and nurses on their staffs, and the surgeon's office knows exactly how to present the "necessity." I think I was also very lucky in this regard, and my suggestion to anyone would be to let your surgeon's office handle the insurance requirements and not get involved unless there is some problem. Good Luck!!!
   — Karen V.

April 22, 2001
My policy also had an exclusion but if you meet the NIH requirements for surgery, then it is considered mediacally necessary and it should be covered. You would not believe the amount of BS insurance companies try to pull to get out of paying for the surgery. Read my profile for what I went through. It was well worth it and I am now happily 4 months post op!
   — Lisa B.

April 22, 2001
The surgeon and your doctor need to say in their requests that the surgery is medically necessary.
   — Cindy H.