Am I correct? Not covered??

[MAMA477 0]

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.

[MlkPas 5]

Looks like your surgery is not covered. But you should be able to use your medical flex money. I was self-pay and used my flex money to reimburse myself for part of the cost of surgery.

[Papillon 7]

Also talk to your bariatric surgeon's staff, they may know about your specific insurance company. Different companies cover different procedures. I do believe that MLKPas is right, you can use your flex pay for medical costs.

[Kelkie 0]

None of my appointments with my surgeon or his PA (for supervised diet) are covered by my insurance until I have a preapproval. I have been using our flex spending for these appointments, and then when/if insurance goes through, then I will get reimbursed from the surgeon's office for the amount I paid that is over the percentage the inusrance would pay.

[Stacy160 201]

Yep, looks like it's specifically excluded. Welcome to the club! Wheeeeee.... LOL. You should be able to apply your flex $$ to it.