Insurance Question

[Missmaureen78 0]

Hi All..i'm new to the forum and have an insurance question. I'm on pins and needles waiting for HR to get back to me on this, so I figured I'd ask y'all if you had any thoughts on the matter.

My company's insurance contract has an exclusion for "treatment of weight reduction or obesity."

I've read that the Band may still be covered, as I'm morbidly obese, and the treatment is not for weight reduction, but rather treatment for co-morbidities that my Dr. feels will arise.

Has anyone had a similar experience? I would HATE to self-pay, but will do what I have to.

THanks

Maureen

[clarityseeker 1]

Most exclusions now say "Any treatment or surgery for obesity, including morbid obestiy". That's how mine is worded and it shuts down the possibility completely.

I have seen language to the effect that "wieght loss surgery is excluded unless medically necessary." Obviously, this is much better for those that meet the FDA guidelines for the Lap Band.

I would argue that the language in your policy that you quoted does not address the "medical necessity" part, so that's what I would work on proving. You should also double-check to make sure there isn't some other part of the policy that applies. Also, make sure you are looking at THE POLICY DOCUMENT, not a summary.

Good luck. I wish I had insurance that covered mine, but it was worth it!