Exclusion Wording-Do I Have a Chance?

[jebcal 0]

Can anyone tell me if I stand a chance on approval if my policy says the following? I have Anthem Blue Cross Blue Sheild.

The following section indicates items that are

excluded from benefit consideration, and are not

considered Covered Services. This information is

provided as an aid to identify certain common

items that may be misconstrued as Covered

Services, but is in no way a limitation upon, or a

complete listing of, such items considered not to

be Covered Services.

We do not provide benefits for procedures,

equipment, services, supplies or charges:

for bariatric surgery, regardless of the

purpose it is proposed or performed.

This includes but is not limited to Roux-en-Y

(RNY), Laparoscopic gastric bypass surgery or

other gastric bypass surgery (surgical

procedures that reduce stomach capacity

and divert partially digested food from the

duodenum to the jejunum, the section of

the small intestine extending from the

duodenum), or Gastroplasty, (surgical

procedures that decrease the size of the

stomach), or gastric banding procedures.

Complications directly related to bariatric

surgery that result in an Inpatient stay or an

extended Inpatient stay for the bariatric

surgery, as determined by Us, are not

covered. This exclusion applies when the

bariatric surgery was not a Covered Service

under this plan or any previous one of Our

Plans, and it applies if the surgery was

performed while the Member was covered by

a previous carrier/self-funded plan prior to

coverage under this Certificate. Directly

related means that the Inpatient stay or

extended Inpatient stay occurred as a direct

result of the bariatric procedure and would

not have taken place in the absence of the

bariatric procedure. This exclusion does not

apply to conditions including but not

limited to: myocardial infarction; excessive

nausea/vomiting; pneumonia; and

exacerbation of co-morbid medical

conditions during the procedure or in the

immediate post-operative time frame.

[shome 0]

Yeah I am thinking you might want to shop around for other insurance or go self pay. It sounds like they don't want to have anything to do with it.

[MyMeshelle 2]

Ya my INS had an exclusion... i ended up fiancing it... i got a loan from BofA... its only $250 a month... so i think of it as a car payment... but forking out 18,000 hurt.... its gonna be so worth it in the end ... im only 4 days post op :eek:

[Kegette 0]

Hi, this type of exclusion is through your employer. Athem BC BS does cover this type of surgery (I have them for my insurance) but your employer can request that certain services not be covered (to save costs). You may want to talk to someone in HR and see if this policy will be changed. Good luck!

[Momto5 0]

I'm Anthem BC/BS in Ohio. Same wording. They say No way. I am self paying....sorry to be the bringer of bad news....

[lele 0]

I also have anthem BCBS, and mine was covered. I agree with Kegette, your employer is probably the reason it is excluded. Good Luck!

[CMTurner 0]

Not only are they not covering the bariatric surgery but, if you self pay and then have to go into the hospital for any complications that THEY determine to be related to the surgery they won't cover that either. I too say talk to your HR or shop for another insurance. Sorry.

[HeatherO 7]

Unfortunately, there is no coverage.