Insurance says they cover for "morbid" obesity but i cant find it in my policy!!

[Melisa1 0]

Im soo frustrated with my insurance right now i could scream!:frown: Ive called them about 6 times now and they say the same thing every time. They say they cover for morbid obesity only. ok...so yes im morbidy obese! ok so i wanted to find that in writing. I searched through all the papers and couldnt find anything talking about bariatric surgery or weight loss surgery. It does state that it doesnt cover weightloss programs???? What the heck?? But everytime i call they tell me its covered for morbid obesity. Ive gotten the booklet from my husbands HR department and it states nothing about WLS. What should i do? They are telling me something i cannnot find anywhere. And ive asked them to send me something in writing and they wont? Anyone know anything or have words of experience or advice for me?? I need it.:thumbup:

[CMTurner 0]

What insurance carrier do you have? Have you tried looking at their website?

[MacMadame 81]

Generally if they don't say, that's good. What you normally see in the booklet is the exclusion for weight loss surgery. The booklet can't possibly cover everything they cover so the main thing is to look at the exclusions and make sure it's not there.

Plus, getting the same answer 6x in a row from an insurance company is a miracle. So I'd go with it. :thumbup:

[shortgal 5]

Your ins. carrier will have to pre-certify the surgery, so now that you know they cover it, ask them what documentation they require for approval.

Have you seen a surgeon yet? The surgeon's office generally knows what papers, tests, etc the ins. companies want.

[JennBand08 0]

Once you schedule surgery, your Dr.'s office will call and 'Pre authorize" your procedure. If it is not covered benefit, you will certainly find out then. But yes.. I agree.. getting the same answer every time you call sounds like its covered.

[JamieNP 20]

Make sure you take down the names of people that you talk with at the insurance company.

Weight loss programs are different than weight loss surgery. Mine covers surgery but not programs.

Good luck!

[Bea1128 1]

I used to file insurance for a living and when they won't tell you one way or the other, they want you to file all of your paperwork for a pre-cert. They do it that way in case they deny you. That way they haven't said yes and they haven't said no. It's an out for them if they need it. Get all of your documentation together and have your surgeon file for a pre-determination. I agree that if it isn't excluded in writing you might have a good shot at getting it covered. When I called my insurance co they told me over the phone they covered WLS if it was "medically necessary". I was approved with no problems. Give it a shot. If they deny you, you can always appeal. Good luck and keep us posted.

[bjblev1215 0]

If they tell you they cover weight loss surgery as a treatment for morbid obesity then I would be estatic. Find a surgeon, get his office to run down the specifics and get it in writing for you...they're professionals out there that can do these things for you...let them handle it. Insurance companies are the worst. Tell me who your insurance co is and I can probably tell you what your looking at...I have worked in several lap band surgeons offices and know a little about insurance...hopefully I can help.

[msjessy 0]

When I was going thru this I got a different answer every time I called the Insurance.

So what I did was call the insurance and asked them to fax me the Policy Information for procedure code 43770.

What they faxed me was the descriptions of morbid obesity, an outline of the different types of surgery the cover, the guidelines for what constitutes medically necessary and what the requirements were for pre-approval. It even gave brief information on what complications they would cover, should they arise.

I would try to go this route if you haven't already tried. I must have read those 13 pages every day for 2 months to make sure I'd be covered. I just couldn't trust the reps "interpretation" of their policy and what the requirements were.

Good Luck!!!

[Melisa1 0]

I have UHC choice plus. Everytime ive called they say its not coverd except for morbid obesity. Ive documented it twice now. But when we look in all our paperwork we cant find it.

[Melisa1 0]

bjblev its UHC choice plus...thank you very much for helping!!!!

[shortgal 5]

I think UHC choice plus requires doucumentation of a five year history of morbid obesity. If that is correct, they will want weights from your PCP or ob gyn for the past five years. Just call and ask them what they require.

[Melisa1 0]

omg dont scare me like that lol....my weight has fluctuated and my bmi has been under forty up and down up and down. its been more like 38-39-38-40 and now its been forty lately. I dont have any co-morbidities except for gastro esophical reflux disease (gerd) which i dont even know if its a true co-morbidity? However, besides the gerd i have arthritis in my right hip, depression/stess anxiety, stress incontience, and asthma symptoms lately. My PCP wrote and "excellent" letter of pre determination too. He thinks this would be the BEST tool for me to prevent diabetes since my dad already had it at my age!! Do you even think i have a fighting chance??

[Melisa1 0]

OH AND....everytime i call my insurance....i ask them if i have to have 5 years of a bmi over 40 and they all say no. They said it doesnt state that in my policy at all!!! Ive documented everything too.?? We cant find it in writing and all they are telling us is it is for "morbid obesity and we have a pre determination letter from the Dr.??

[shortgal 5]

Don't make yourself crazy (yet) just call them and ask. then get all the documentation you can get your hands on. Good Luck.