Sleevedmedic 59 Posted March 23, 2013 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. Share this post Link to post Share on other sites
DrmBig4Evr 152 Posted March 23, 2013 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. Share this post Link to post Share on other sites
anniemay 150 Posted March 23, 2013 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 Share this post Link to post Share on other sites
Sleevedmedic 59 Posted March 23, 2013 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. Share this post Link to post Share on other sites
Sleevedmedic 59 Posted March 23, 2013 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. Share this post Link to post Share on other sites
Sleevedmedic 59 Posted March 23, 2013 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. Share this post Link to post Share on other sites
