Question:
Truth or Myth? Major Insurance Companies are...

Major Insurance Companies are looking at changing their process for approval at the end of this year?? Truth or Myth? My psych told me today that I am right in the 'window of opportunity' to get my surgery because things are "going to change drastically at the end of the year". Has anyone heard something to this effect? Thanks    — Lily C. (posted on July 2, 2002)

July 2, 2002
From what I've been able to gather this is basically the same as a bad rumor. It's been spreading for years and more companies now cover the surgery than ever before (article after article attests to this). Many countries and now states within the US are now forcing the coverage of WLS when medically necessary. I just don't see them realistically quitting the coverage across the board. Maybe your particular insurance is considering it and that is what your doc was talking about. Maybe he/she was referring to how they determine medical need. Maybe...? Anyway, I've read back in the archives on here and it seems this same message in one form or another has been floating around for a long time now. But to me it's like transplant surgeries. Many insurers refused coverage in the early days because the complications and mortality rates were too high to merit the expense. As surgeries advanced, those rates improved and insurers are more willing to cover the costs. I think this will be and is true of WLS. JMHO!
   — [Deactivated Member]

July 2, 2002
My surgeon made mention of this in his newsletter and asked us to become politically active to help those that come after us.
   — faybay

July 3, 2002
Having worked for major health insurance companies for 15 years, I would say this a myth too. However, a lot depends on the TYPE of insurance you have. For example, HMO or EPO coverage is by FAR the most restrictive type of health care coverage there is versus a PPO plan. Therefore, those plans might not approve the surgery as easily.
   — Patty H.

July 3, 2002

   — Amber L.