Insurance question.

[Sleevedmedic 59]

My wife is wanting to have gastric sleeve done and we just added her to my insurance plan this year. i was just wondering if anyone insurance had a pre existing clause and if so, could you have surgery if you completed all the requirements needed for surgery. if you have never been medically treated for obesity beforehand. Or if you had to wait to have your insurance a complete year before they would approve it.

[DrmBig4Evr 152]

Well I would think it is a stupid clause if its pre-existing because everyone on here would be disqualified. Its not like we got overweight overnight. As for insurance, I had one insurance deny me two years ago as I wasn't over the BMI consistantly for 5 years so the years I lost weight and went to the doc and weighed in didn't count. This year I have different insurance and the only requirement was over 40 BMI or 35 BMI with one comorbidity from their approved list. Also, psych, nutritional eval, a list of diets only.

[anniemay 150]

I have never heard of it being a ore-existing condition. It basically comes down to the plan your employer chooses. Approval for these surgeries are becoming more common in regular health plans because of the long term savings from the effects of obesity - diabetes HBP heart disease. Also most plans eventually fall in line with Medicare guidelines (with Medicare being the slowest to cover new procedures). Medicare just this year has added the sleeve to a covered service. Before that bypass was the only option.

(I work on the business end of healthcare so have a fairly good understanding of some of these issues) Hope this helps

[Sleevedmedic 59]

Well they told me it was a clause in place where she didn't have insurance for 2 yrs then I added her to my insurance and that they said there would be a pre existing clause on everything she was treated for with her previous insurance. That she has to have this insurance for a year. But I told them she has never been treated medically by a doctor.

[Sleevedmedic 59]

But when I talked to the bariatric team over my insurance that approves the surgery they told me there was no pre existing clause so I don't have a clue. One person told me there was and another said there wasn't.

[Sleevedmedic 59]

Well I would think it is a stupid clause if its pre-existing because everyone on here would be disqualified. Its not like we got overweight overnight. As for insurance' date=' I had one insurance deny me two years ago as I wasn't over the BMI consistantly for 5 years so the years I lost weight and went to the doc and weighed in didn't count. This year I have different insurance and the only requirement was over 40 BMI or 35 BMI with one comorbidity from their approved list. Also, psych, nutritional eval, a list of diets only.[/quote']

Who is your insurance through. That what I though that if she has never been treated medically I don't know how it would be considered pre existing. But like you said we didn't get this way overnight so it is kinda stupid to me also.