HELP!! What do you think? Insurance ???

[88Shelly88 0]

Well I looked up my plan (while I am still waiting to hear officially from my HR dept at work on if my Lap Band Surgery would be covered or not) but this is a VERY small protion of what I found? What do you think??

Medically necessary or medical necessity means the extent of services required to diagnose or treat a bodily injury or sickness which is known to be safe and effective by the majority of qualified practitioners who are licensed to diagnose or treat that bodily injury or sickness. Such services must be:

1. Performed in the least costly setting required by your condition;

2. Not provided primarily for the convenience of the patient or the qualified practitioner;

3. Appropriate for and consistent with your symptoms or diagnosis of the sickness or bodily injury under treatment;

4. Furnished for an appropriate duration and frequency in accordance with accepted medical practices, and which are appropriate for your symptoms, diagnosis, sickness or bodily injury; and

5. Substantiated by the records and documentation maintained by the provider of service.

Medicaremeans Title XVIII, Parts A and B of the Social Security Act, as enacted or amended.

Mental disordermeans a mental, nervous, or emotional disease or disorder of any type as classified in the Diagnostic and Statistical Manual of Mental Disorders, regardless of the cause or causes of the disease or disorder.

Morbid obesity means a body mass index (BMI) of 40 kilograms per mass squared or 100 pounds or more over your ideal weight as determined by the Metropolitan Life Height and Weight Tables for Men and Women, as of the date of service.

THIS IS LISTED UNDER TREATMENTS NOT COVERED UNDER PLAN:

31. Services for the treatment of obesity;that is not morbid obesity (clinically severe obesity);

I fall under the MORBID obesity as I am 5'1" and weigh 235, putting me at over a 43 BMI???

[trish5713 2]

sounds like it should be covered. have you talked to your insurance people on the phone? i tried reading my plan and almost went crosseyed so i just called them. they were actually really helpful