Question:
This is what my member handbook says about WLS..

Hello everyone, Well Idug out my Lifeguard POS member handbook to see what they said about WLS..So here goes... I found it under Exclusions and Limitations: It says the folling services are excluded from coverage, or are covered only in specific instances, as described in the Evidence of Coverage. Exclusions from coverage include all services, supplies, and benefits that are: 1) Not medically necessary; 2) Not specigically described in this Evidence of Coverage; 3) Under Level One, not provided by Contracting Providers; Then under the heading: Obesity and Weight Reducation it states: Surgical treatment is limited to Members with a diagnosis or morbid obesity and significant co-morbidities, who have failed medically supervised non-surgical alternatives. Experimental and investigational procedures for the tratment of all levels of obesity are not covered. Also excluded are nutritional conseling and weight reduction programs and services. I stated that word for word not missing anything...Can someone tell me what they mean???? Will they cover WLS??? I do qualify for the surgery I am 24 years old (Today is my b-day!!!!) 275 pounds and I am 5'1 leaving me with a BMI of 55...I also have Type II diabetes, and many other problems associated with my morbid obesity. Well thanks for listening to me I really could use some help... -Dusty    — Dusty S. (posted on June 8, 2001)

June 8, 2001
Happy Birthday! Sounds like they will cover the surgery provided your doctor states some recognized co-morbidities and you stick with a common surgical treatment like RNY. Congrats!
   — Allie B.

June 9, 2001
Happy Birthday!! Your surgery should be covered with no problem. Just make sure that you find out exacty what they need as far as records and then get the records to them. Usually the surgeon's office is very good about handling the necessary paper work. Good Luck
   — Helen C.