Clear as Mud???

[skinnydesires 0]

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:

[karenintx 0]

I have Unicare - mine will pay for nothing. I was self-pay.

[vegwannabe 1]

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.

[MacMadame 81]

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!!

[skinnydesires 0]

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!