Insurance exclusion but still approved for surgery

[nzuribelle 0]

So I'm going through Oband. They are they only ones that want to try to get me approved for surgery since it's an exclusion on insurance plan. Has anyone with an exclusion for bariatric surgery still get approved through the appeals process? There isn't a lot a I can find on this subject. I called my insurance company probably a million times and each time there's a different answer some say yes it can be done and others say not it can't . I'm confused . I just need more info on this.

[Lannie 135]

Generally if WLS is specifically excluded from the plan coverage, an appeal will not change that. The insurance has a strong position...WLS is expressly excluded and you bought the policy knowing it was excluded.

Usually, you would need to change insurance plans or consider self pay.

[ready2inspire 19]

My insurance has wls specifically excluded in the policy. I my doctors office billed for a hernia repair (which was needed) to cover half the cost. I financed the rest. They said most overweight people have that kind of hernia.

[nzuribelle 0]

My insurance has wls specifically excluded in the policy. I my doctors office billed for a hernia repair (which was needed) to cover half the cost. I financed the rest. They said most overweight people have that kind of hernia.

Wow ok. That's good to know. How much is the actual surgery ?

[OutsideMatchInside 10,166]

23 hours ago, ready2inspire said:

My insurance has wls specifically excluded in the policy. I my doctors office billed for a hernia repair (which was needed) to cover half the cost. I financed the rest. They said most overweight people have that kind of hernia.

A lot of insurance companies frown on this and consider it a form of insurance fraud. So the ability to use this will vary.

[ready2inspire 19]

I think they said $10k. So I paid $5k

[k2389 0]

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