Guest guest Posted January 1, 2004 Report Share Posted January 1, 2004 It's all confusing when you read it but, if you read this it actually says that things are excluded BUT will not apply to Medical Treatment, etc..... which actually means that IF IT IS FOUND MEDICALLY NECESSARY YOU WILL BE APPROVED!!!! This is good news!!! Be sure to visit your PCP, and generally, if you have had the same doc for years, you've probably noted that you have tried many other diets. Medically necessary is different with each insurance company and you can call them to ask " WHAT criteria must you meet in order to be approved " . This question I asked my company and they told me that my BMI had to be over 40, I had to be 100 lbs. overweight, I have had medically supervised diets, I had to be over 25 and another I can't remember but I met all the criteria. Don't panic about the medically supervised diets though. That could mean simply a couple years ago you visited the doc and he/she took your weight and said, do Atkins or something. My doc wrote a nice letter tht said I was her patient for over 6 years and have failed several attempts of dieting. She mentioned my arthritis, high blood pressure and general difficulty in exercise or whatever. I gave a copy of this to my Surgeon and they sent it along with his determinations to the insurance company. Keep the faith hon, it's coming!!!! Insurance Question? This is what it say`s in my book and it is under Exclusions and Limitations..... All services and Medication for the purpose of weight reduction, including but not limited to the surgical treatment of Morbid Obesity (e.g. gastric Bypass restrictive, intestinal bypass and repeat and reversal procedures). This exclusion will not apply to Medical treatment, including but not limited to medication, surgery and nutrition counselling, for treatment of Morbid Obesity. Treatment of Morbid Obesity, following the initial visit/diagnosis, must have prior authorization. Can anyone tell me what this all means, does it mean it will cover the sugery for Morbid Obesity? H Pre Op _____ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 1, 2004 Report Share Posted January 1, 2004 It's all confusing when you read it but, if you read this it actually says that things are excluded BUT will not apply to Medical Treatment, etc..... which actually means that IF IT IS FOUND MEDICALLY NECESSARY YOU WILL BE APPROVED!!!! This is good news!!! Be sure to visit your PCP, and generally, if you have had the same doc for years, you've probably noted that you have tried many other diets. Medically necessary is different with each insurance company and you can call them to ask " WHAT criteria must you meet in order to be approved " . This question I asked my company and they told me that my BMI had to be over 40, I had to be 100 lbs. overweight, I have had medically supervised diets, I had to be over 25 and another I can't remember but I met all the criteria. Don't panic about the medically supervised diets though. That could mean simply a couple years ago you visited the doc and he/she took your weight and said, do Atkins or something. My doc wrote a nice letter tht said I was her patient for over 6 years and have failed several attempts of dieting. She mentioned my arthritis, high blood pressure and general difficulty in exercise or whatever. I gave a copy of this to my Surgeon and they sent it along with his determinations to the insurance company. Keep the faith hon, it's coming!!!! Insurance Question? This is what it say`s in my book and it is under Exclusions and Limitations..... All services and Medication for the purpose of weight reduction, including but not limited to the surgical treatment of Morbid Obesity (e.g. gastric Bypass restrictive, intestinal bypass and repeat and reversal procedures). This exclusion will not apply to Medical treatment, including but not limited to medication, surgery and nutrition counselling, for treatment of Morbid Obesity. Treatment of Morbid Obesity, following the initial visit/diagnosis, must have prior authorization. Can anyone tell me what this all means, does it mean it will cover the sugery for Morbid Obesity? H Pre Op _____ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 2, 2004 Report Share Posted January 2, 2004 Hi ---that is about what mine said as well. After looking into it I called and their limitation was that uit would be covered only if you were considered morbidly obese (100 pounds overweight). Some require that your have some pre-existing medical problems for it---and that you follow a diet plan for up toa year---my best friend has ran into that. I have Anthem Healthkeepers and mine was approved in 2 weeks---with no other real medical problems as of yet other than the weight--CIndy Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 2, 2004 Report Share Posted January 2, 2004 Hi ---that is about what mine said as well. After looking into it I called and their limitation was that uit would be covered only if you were considered morbidly obese (100 pounds overweight). Some require that your have some pre-existing medical problems for it---and that you follow a diet plan for up toa year---my best friend has ran into that. I have Anthem Healthkeepers and mine was approved in 2 weeks---with no other real medical problems as of yet other than the weight--CIndy Quote Link to comment Share on other sites More sharing options...
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