Can anyone tell me if I stand a chance on approval if my policy says the following? I have Anthem Blue Cross Blue Sheild.
The following section indicates items that are
excluded from benefit consideration, and are not
considered Covered Services. This information is
provided as an aid to identify certain common
items that may be misconstrued as Covered
Services, but is in no way a limitation upon, or a
complete listing of, such items considered not to
be Covered Services.
We do not provide benefits for procedures,
equipment, services, supplies or charges:
for bariatric surgery, regardless of the
purpose it is proposed or performed.
This includes but is not limited to Roux-en-Y
(RNY), Laparoscopic gastric bypass surgery or
other gastric bypass surgery (surgical
procedures that reduce stomach capacity
and divert partially digested food from the
duodenum to the jejunum, the section of
the small intestine extending from the
duodenum), or Gastroplasty, (surgical
procedures that decrease the size of the
stomach), or gastric banding procedures.
Complications directly related to bariatric
surgery that result in an Inpatient stay or an
extended Inpatient stay for the bariatric
surgery, as determined by Us, are not
covered. This exclusion applies when the
bariatric surgery was not a Covered Service
under this plan or any previous one of Our
Plans, and it applies if the surgery was
performed while the Member was covered by
a previous carrier/self-funded plan prior to
coverage under this Certificate. Directly
related means that the Inpatient stay or
extended Inpatient stay occurred as a direct
result of the bariatric procedure and would
not have taken place in the absence of the
bariatric procedure. This exclusion does not
apply to conditions including but not
limited to: myocardial infarction; excessive
nausea/vomiting; pneumonia; and
exacerbation of co-morbid medical
conditions during the procedure or in the
immediate post-operative time frame.
