Coverage Booklet

[Guest guest]

Hey everyone!

I have a question about BCBS. I read in my certificate booklet that it

won't

cover gastic bypass.

It reads:

Any serfices or supplies for the treatment of obesity, including but not

limited to, weight reduction, surgical care, medical care or

Prescription

Drugs, or dietary control related to covered nutritional sustenance

products

(food) related to enteral feeding except when it's the sole mean of

nutrition.

Food supplements. Services for Inpatient treatment of bulimia, anorexia

or

other eating disorders which consist primarily of behavior modification,

diet

and weight monitoring and education. Any services or supplies that

involve

weight reduction as the main method of treatment, including medical,

surgical

or psychiatric care or counseling. Weight loss programs, nutritional

supplements, appetite suppressants, and supplies of a similar nature.

Procedures including but not limited to liposuction, gastric bypasses,

gastric

balloons, stomach stapling, jejunal bypasses, and wiring of the jaw.

I have BCBS of Georgia and it's an HMO. It also says:

Benefits

All covered services must be medically necessary

Does anyone else out there have this kind of clause in there benefits.

And if

so, has anyone been approved by there insurance company with this clause

in it?

Any help would be greatly appreciated!!!!

King

Phenix City, Alabama

Weight = 270 lbs.

Height = 5'3 "

BMI = 47

[Guest guest]

--

I have BC/BS of Georgia (POS)and just last week received an update. My old plan

was worded similar to yours in that it didn't cover surgical or medical care for

obesity, weight reduction, or weight control, but now it says in the Exclusions

section " Surgical or medical care for obesity, weight reduction, weight control

(except for medically necessary treatment; e.g. gastroplasty or gastic bypass).

.. . "

I don't know if this is a difference between POS and HMO or if they have just

started covering medically necessary gastric bypasses. Can you change to POS?

Hope this helps.

Maggi

In a message dated Mon, 21 Aug 2000 1:59:49 PM Eastern Daylight Time, "

King " writes:

<< Hey everyone!

I have a question about BCBS. I read in my certificate booklet that it

won't

cover gastic bypass.

It reads:

Any serfices or supplies for the treatment of obesity, including but not

limited to, weight reduction, surgical care, medical care or

Prescription

Drugs, or dietary control related to covered nutritional sustenance

products

(food) related to enteral feeding except when it's the sole mean of

nutrition.

Food supplements. Services for Inpatient treatment of bulimia, anorexia

or

other eating disorders which consist primarily of behavior modification,

diet

and weight monitoring and education. Any services or supplies that

involve

weight reduction as the main method of treatment, including medical,

surgical

or psychiatric care or counseling. Weight loss programs, nutritional

supplements, appetite suppressants, and supplies of a similar nature.

Procedures including but not limited to liposuction, gastric bypasses,

gastric

balloons, stomach stapling, jejunal bypasses, and wiring of the jaw.

I have BCBS of Georgia and it's an HMO. It also says:

Benefits

All covered services must be medically necessary

Does anyone else out there have this kind of clause in there benefits.

And if

so, has anyone been approved by there insurance company with this clause

in it?

Any help would be greatly appreciated!!!!

King

Phenix City, Alabama

Weight = 270 lbs.

Height = 5'3 "

BMI = 47

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