Guest guest Posted August 14, 2000 Report Share Posted August 14, 2000 Hi Gang! I'm very interested in having MSB surgery. I have an appointment with my primary care doctor tomorrow...to see if he'll give me an okay. I have QualChoice insurance, have any of you used that insurance to have the surgery. I called them and was told they would not pay for the surgery unless it was for medical reasons. I would appreciate any helpful hints or advice to help me get through this process. Thanks in advance for any help. My e-mail address is kkislek@.... I live in ville, North Carolina. Phone number is at home, at work. Kathy Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 14, 2000 Report Share Posted August 14, 2000 Hi Kathy, I don't know about your specific insurance company, but I think most, if not all, will only pay for WLS when it is medically necessary. But I think you can almost always make a case for it being medically necessary. Just morbid obesity itself is a very life threatening medical condition. Also, almost everyone who is morbidly obese has some specific health problems related to it such as high blood pressure, diabetes, high cholesterol, reflux, arthritis or aching joints, breathlessness, incontinence, menstrual problems, etc. etc. You'll probably just have to document some of those things for them, or if you are lucky they will consider morbid obesity (40 BMI or above) itself to be a medical reason. When you see your doctor try to get him to put everything that is wrong with you that could in any way be related to weight in your records. Mine wrote down every little thing that was wrong with me, even if he wasn't treating me for it, and I'm sure that helped me get approved by my insurance. Try to find out exactly what type of documentation your insurance company needs, and then give that to them. I had a hard time finding out what my insurance company needed until my case was given a number and assigned to a case manager. Then we spoke directly with that case manager, and she faxed us a list of exactly the information they wanted. Once they had everything they wanted in their hands, I was quickly approved. But all insurance companies are a little different, so your experience may not be quite the same. One thing they all seem to have in common, though, is that they will claim they have not received your paperwork. We had a problem with that until we got my case number and the name and correct fax number (they like to give you wrong numbers, too) and address to send everything to. Then things started getting there, but we always called to verify that the info had been received. Good luck to you! Sara MGB 8/2 kkislek@... wrote: > Hi Gang! > > I'm very interested in having MSB surgery. I have an appointment > with my primary care doctor tomorrow...to see if he'll give me an > okay. I have QualChoice insurance, have any of you used that > insurance to have the surgery. I called them and was told they would > not pay for the surgery unless it was for medical reasons. I would > appreciate any helpful hints or advice to help me get through this > process. Thanks in advance for any help. > > My e-mail address is kkislek@.... I live in ville, > North Carolina. Phone number is at home, > at work. > > Kathy > Quote Link to comment Share on other sites More sharing options...
Recommended Posts
Join the conversation
You are posting as a guest. If you have an account, sign in now to post with your account.
Note: Your post will require moderator approval before it will be visible.