Thanks!
Ta-Tanisha

*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