Obesity surgery

4 Responses to “I am new”

1. Leah Margurite Says:
   October 22nd, 2005 at 6:13 pm

   Jen

2. Frieda Alysia Says:
   October 23rd, 2005 at 3:53 am

   Well I was apv for the insurance coverage. It started jan 1, 2003 . My policy
   does have and exclusion on it. It states:

   *medical or surgical treatment for obesity,unless otherwise specified in the
   covered services

   *Medical or Surgical treatment or regimen for reducing or controlling weight,
   unless otherwise specified in the covered services

   I called the ins company and asked what they meant by otherwise specified in the
   covered services They said if it is med nec it will be covered. I looked under
   covered services and it does say all med nec procedures will be covered.

   This is B/C B/.S carefirst open enrollment individual plan. I called the ins
   company many times and 9 out of 10 say that it will be covered if med nec.
   

   However I spoke with someone today who said "What I got was a letter from them
   stating that the second part means that if my contract specifically stated that
   gastric bypass was covered if deemed medically necessary that then and only then
   would they approve irregardless of the exclusion. Since my contract doesn’t
   mention gastric bypass specifically at all I am not going to get coverage at
   all." Then when the preauthorization letter was submitted by the surgeon the
   major medical division (the ones who do the authorizations) stated there is an
   exclusion in the small group contract:"

   Now this is what she told me. However I am under an individual contract not a
   group contract so I would think the mandates would cover it as MO being MED NEC.
   I need some input. We have the same exclusion. but I belive diffrent types of
   ins……

   Maricha

   Maricha
   geocities.com/mywlsprogress

3. Elwood Caitlyn Says:
   October 23rd, 2005 at 9:29 am

   Jen

4. merle70 Says:
   November 14th, 2005 at 3:32 pm

   Hi, Jen. I’m fairly new to the group too and I never post, but I’m very
   interested in finding out how you got ALL of your plastic surgery paid for. I
   have pretty good health insurance which paid 100% for my Gasrtic Bypass
   surgery(which was Nov. 25, 2002) , but I’m not so sure they will pay for
   plastic surgery. I’m 32 years old and my beginning weight was 245 lbs. and so
   far I’ve lost 60 lbs. I’m interested in having tummy, thighs, arms, and boobs
   done. Can you give me some suggestions? Also, how did you get to goal weight
   so fast. I would also appreciate advise from anyone else who has any.

   Thanks!
   Ta-Tanisha

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