Guest guest Posted November 25, 2001 Report Share Posted November 25, 2001 Wow, Roxanne, that's a pretty detailed exclusion! I'm not sure if you could get around that one, especially if they say 'excluded even if medically necessary' When is open enrollment at your company ? Is it possible for you to switch to a different insurance company, preferably a PPO since they're generally easier for approvals ? I waited until open enrollment in my company and switched from Kaiser HMO to Great West PPO. Kaiser even covered WLS, but they didn't cover the DS and also only did an open, proximal RNY, at least in Colorado. I had my DS surgery with Dr Keshishian on 11/08/01 and was approved by Great West PPO within 24 hours. I did have to wait a year before that for open enrollment at my company, but once I had my new insurance, everything went smoothly! Anita Surgery 11/08/01 Dr Keshishian > Hi all, I posted this on the DS Authorization Site with no responce. > I figured that most of you have gotten approval and had your surgery > so mabe you could help. I just received my policy book for the new > insurance company and under the Limitations and Exceptions it reads: > > " Exogenous or morbid obesity including any surgery, revision or > repair as a result thereof. Additionally excluded are any expenses, > services or treatments for any form of food supplement or > augmentation (unless necessary to sustain life in a critically ill > person); or for any exercise program; or for weight controll (other > than under Plan's weight loss benefit) or removal of weight or fat, > whether for obesity or for any other diagnosis and whether by diet, > injection of any fluid, or use of any medication or surgery of any > kind. " > > Has anyone gotten an approval with this statement? In my BCBS it was > more detailed even as far as to say denied " Even if medically > necessary " . I had VBg in '95 and want a revision. Does anyone think I > have a chance with this insurance? It is medically necessary as I > have many co-morbid conditions. The agent that sold me the policy > said that it was covered if medically necessary, but there is also a > statment in the book that coveres them on agents giving out the wrong > info. I am besides myself with worry that I won't get the ins. to > pay. Any input will be greatly appericated. > Thanks, Roxanne Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 25, 2001 Report Share Posted November 25, 2001 Hi Anita, the new policy does not state even if medically necessary. My old BCBS did. I am self employed and just got this new policy for small businesses. It took me a long time to find an insurance company to cover me at my weight. The agent assured me that if it was medically necessary they would cover it. Now that I have my policy book I am not sure what to think. Thanks, Roxanne Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 25, 2001 Report Share Posted November 25, 2001 Hi Dee, nothing was put in writing. I just went on what he told me on 3 seperate occasions. This company is also insured againte statments made by agents. I plan on calling the company tomorrow to find out exactly what is covered. Wish me luck. Roxanne Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 25, 2001 Report Share Posted November 25, 2001 In a message dated 11/25/01 7:15:10 PM Eastern Standard Time, duodenalswitch writes: << I am besides myself with worry that I won't get the ins. to > pay. Any input will be greatly appericated. > Thanks, Roxanne >> Roxanne - I think this guy must not have had a copy of the policy when he sold it to you. I *used* to sell insurance, and *I* would not have said something was covered unless I knew it was. I do not see anything about this surgery being covered if medically necessary. " Exogenous or morbid obesity including any surgery, revision or > repair as a result thereof. Next sentance - expenses services or treatments for any form of food supplement (unless necessary to sustain life......) that paragraph makes that distinction. Additionally excluded are any expenses, > services or treatments for any form of food supplement or > augmentation (unless necessary to sustain life in a critically ill > person); I think this guy didn't know what he was selling and I would get my money back from him, unless you want to have *some* medical insurance. But I do not think your policy covers wls since it specifically states it does not cover surgery and specifically states morbid obesity. That is the problem with small group policies.....they are much stricter. Maybe you could get a job with good insurance for a short time? Carole Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 25, 2001 Report Share Posted November 25, 2001 with the new policy wording, i think you have a loophole with the medically necessary approach. go for it! it'll save your life. mary y > Hi all, I posted this on the DS Authorization Site with no responce. > I figured that most of you have gotten approval and had your surgery > so mabe you could help. I just received my policy book for the new > insurance company and under the Limitations and Exceptions it reads: > > " Exogenous or morbid obesity including any surgery, revision or > repair as a result thereof. Additionally excluded are any expenses, > services or treatments for any form of food supplement or > augmentation (unless necessary to sustain life in a critically ill > person); or for any exercise program; or for weight controll (other > than under Plan's weight loss benefit) or removal of weight or fat, > whether for obesity or for any other diagnosis and whether by diet, > injection of any fluid, or use of any medication or surgery of any > kind. " > > Has anyone gotten an approval with this statement? In my BCBS it was > more detailed even as far as to say denied " Even if medically > necessary " . I had VBg in '95 and want a revision. Does anyone think I > have a chance with this insurance? It is medically necessary as I > have many co-morbid conditions. The agent that sold me the policy > said that it was covered if medically necessary, but there is also a > statment in the book that coveres them on agents giving out the wrong > info. I am besides myself with worry that I won't get the ins. to > pay. Any input will be greatly appericated. > Thanks, Roxanne 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.