Jump to content
×
Are you looking for the BariatricPal Store? Go now!

Clear as Mud???



Recommended Posts

So we finally got switched to our new insurance which is Unicare. I was planning on getting the lapband this spring but I got the shock of my life and found out we are pregnant with our 5th baby. So of course, the lapband is on hold till at least the fall.

In the meantime I thought I would see if the new insurance would even cover the surgery. There was nothing in the paperwork so I emailed them and just got this response back:

GENERAL MEDICAL EXCLUSIONS:

Treatment for obesity or services performed primarily for weight loss or

control (including gastric bypass and gastric staplings); but this

shall not exclude procedures that are necessary due to a specific

condition caused by another illness or for morbid obesity as determined by the plan.

Is it just me, or did that not really answer anything???!!! I guess I will just have to call them on Monday.

Grrrrrrrrrrrrrrrrr:rolleyes:

Share this post


Link to post
Share on other sites

It reads like if you are "morbidly obese", whatever their definition of that is, it is covered. Best thing is to call on Monday and ask them for a written statement of the exclusions, what is covered, and under what circumstances (i.e. what are the "other conditions" and how your plan determines "morbid obesity."

Good luck.

Share this post


Link to post
Share on other sites

GENERAL MEDICAL EXCLUSIONS:

Treatment for obesity or services performed primarily for weight loss or

control (including gastric bypass and gastric staplings); but this

shall not exclude procedures that are necessary due to a specific

condition caused by another illness or for morbid obesity as determined by the plan.

This means they won't cover it if you just want to lose a few pounds. But they will cover it if you have co-morbidities or you are morbidly obese.

I went through this discussion with one of the insurance companies my company uses. That's what they said it means. (They had the same language.)

Of course, after doing all this research I get my open enrollment packet in the mail Sat. and they've changed the plan I was going to switch to and now I have to make all those phone calls again!! :)

Share this post


Link to post
Share on other sites

Thanks guys! I am trying not to get my hopes up so we shall see what they say on Monday. It just irritates me that they couldnt answer my dang question with a straight forward answer. But that is an insurance company for ya! I will definitely get a list of my exclusions because that should have been included with all my original papers. Not sure why they left that out!

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now

  • Trending Products

  • Trending Topics

  • Recent Status Updates

    • cryoder22

      Day 1 of pre-op liquid diet (3 weeks) and I'm having a hard time already. I feel hungry and just want to eat. I got the protein and supplements recommend by my program and having a hard time getting 1 down. My doctor / nutritionist has me on the following:
      1 protein shake (bariatric advantage chocolate) with 8 oz of fat free milk 1 snack = 1 unjury protein shake (root beer) 1 protein shake (bariatric advantage orange cream) 1 snack = 1 unjury protein bar 1 protein shake (bariatric advantace orange cream or chocolate) 1 snack = 1 unjury protein soup (chicken) 3 servings of sugar free jello and popsicles throughout the day. 64 oz of water (I have flavor packets). Hot tea and coffee with splenda has been approved as well. Does anyone recommend anything for the next 3 weeks?
      · 1 reply
      1. NickelChip

        All I can tell you is that for me, it got easier after the first week. The hunger pains got less intense and I kind of got used to it and gave up torturing myself by thinking about food. But if you can, get anything tempting out of the house and avoid being around people who are eating. I sent my kids to my parents' house for two weeks so I wouldn't have to prepare meals I couldn't eat. After surgery, the hunger was totally gone.

    • buildabetteranna

      I have my final approval from my insurance, only thing holding up things is one last x-ray needed, which I have scheduled for the fourth of next month, which is my birthday.

      · 0 replies
      1. This update has no replies.
    • BetterLeah

      Woohoo! I have 7 more days till surgery, So far I am already down a total of 20lbs since I started this journey. 
      · 1 reply
      1. NeonRaven8919

        Well done! I'm 9 days away from surgery! Keep us updated!

    • Ladiva04

      Hello,
      I had my surgery on the 25th of June of this year. Starting off at 117 kilos.😒
      · 1 reply
      1. NeonRaven8919

        Congrats on the surgery!

    • Sandra Austin Tx

      I’m 6 days post op as of today. I had the gastric bypass 
      · 0 replies
      1. This update has no replies.
  • Recent Topics

  • Hot Products

  • Sign Up For
    Our Newsletter

    Follow us for the latest news
    and special product offers!
  • Together, we have lost...
      lbs

    PatchAid Vitamin Patches

    ×