Question:
Can an insurance company not cover this surgery?

My insurance company, an HMO, told my Dr's office they don't cover the surgery. This is after I'd been referred to the Surgery Dr. for the 3rd time. Why did they not say that the 1st time I was referred?    — Michelle E. (posted on March 4, 2003)

March 4, 2003
Hi, I originally had an HMO through M-plan and I had a letter from my doctor and was denied. M-plan than said if I took this class they were recommending (F.L.E.X.) and completed it they would reimburse me for the class and would possibly rethink their decision after 18 months of documented (by Dr or dietician) attempted weight loss. Hello! That is for the birds! People told me I should have appealed but I just didn't feel like hassling with it at the time. I decided when reenrollment time for insrance rolled around I was switching over to United Health Care-PPO. So, now I have a consultation scheduled March 24th with the surgeon i hope to have do the surgery. Long story short...call your insurance company ask them to read that part of the policy to see if it specifically states no coverage. My policy says it will cover it if the Dr deems it medically neccessary. Ask baout appealing to see if it would do any good. Look into other insurance options...at my work (Target) we have a choice of two very different health plans..HMO or PPO. I think PPO is definitely the way to go. Good luck! I hope this helped a little at least for you.
   — kathleen-Joan piper

March 4, 2003
What state are you in? In Ohio an HMO must cover this surgery if it is medicaly nessecary. Good luck.
   — Christine A.