Question... Not covered still paid.

[tiaariel 0]

So Bariatric surgery is not covered on my insurance but with all my health issues my doctor seems to think my insurance will cover it.... Has anyone's insurance covered it even though it's not listed??

[ChristyAZ 87]

Not if its an excluded benefit. Medically nesecary or not, if its excluded from your plan, its excluded. Happened to me last year.

[Jersrose43 837]

It's really sad when doctors offices set wrong expectations.

If it's a benefit exclusion it definitely will not be paid for regardless of medical reason

Call your insurance and confirm it's a benefit exclusion

[tiaariel 0]

I called my insurance company. They told me it was an exclusion but to have my doc call to see if my health issues will get it covered.

I'm so confused!! Were you guys able to get the surgery done??

[ChristyAZ 87]

I was NOT able to get my procedure covered by my insurance last year even with 2 comorbidities. My policy stated that there was a Bariatric Surgey Exclusion. My medical necessity did not matter. My company did not pay the premium to include bariatric surgery on our group policy, making it an exclusion on our policy. So no, they would not cover it and I had to wait till open enrollment to drop that policy.

[tiaariel 0]

<p>I was NOT able to get my procedure covered by my insurance last year even with 2 comorbidities. My policy stated that there was a Bariatric Surgey Exclusion. My medical necessity did not matter. My company did not pay the premium to include bariatric surgery on our group policy, making it an exclusion on our policy. So no, they would not cover it and I had to wait till open enrollment to drop that policy.</p>

This is all mine states:

"Surgical and non-surgical treatment of obesity."

[Jersrose43 837]

This is all mine states: "Surgical and non-surgical treatment of obesity."

So I work in insurance for last 20 years. I say you go forward if this is what it says.

Read the policy THOROUGHLY

If it's online do a suearch for gastric, bariatric, sleeve etc. If it doesn't exclude it, this clause tells me it's covered