OK - This (copied below starts with "33.") is from the "not covered" section of my plan - Anthem Lumenos.. not good, please confirm? If I have flex benefits $ am I able to use that to pay against the surgery if I am a self pay?
My husband works for a hospital and they are changing their policy this next year due to the increase in bariatric surgeries, go figure! So I'm going to have to wait until October to try to figure that out. I'm trying to stay positive and use this time for research and learning. I am going to a learning session on 6/12 and hope it doesn't depress me.
Thanks for sharing your opinion...
33. 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 Anthem plan, 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.
