HELP! "Rider"=exclusion?

[deanna 1]

I have been waiting for my surgery because I just got a new job, and they offer Excellus bc/bs, which I thought would be good. I called the company and they said they cover lapband, but I just got my manual in the mail today, and there is a page in there labeled "RIDER TO EXCLUDE COVERAGE FOR WEIGHT LOSS SERVIES" that says my company has opted to not pay for WLS unless "medically necessary". At the age of 21, I'm almost 300 pounds with at least 4 co-morbidities...I would assume that's medical necessity, right???

Should I start my riot act now, or wait and see if the insurance request goes through? Hahahaha. Actually, I was just wondering if anyone has been through this, and what their process was like!:faint:

[anonemouse 1]

The key words there are "medically necessary." You need to find out their standards for "medically necessary" surgery. I would assume that you are fine, though, since you have a BMI of at least 40 and have co-morbidities.

[Wheetsin 714]

A rider is a way to make a change to a contract once the contract has been put in force. Think of it like an ammendment.

Laurend is right - check with your provider on their definition of medically necessary. Providers can be arbitrary about this so no one can tell you "for sure" whether or not you would be covered other than them.