annk , 01-24-2011 02:18 PM
Hello! I have an appointment with a local hospital's weight loss services (referral from my primary care provider) and am excited to learn more about weight loss surgery. I know my insurance won't cover it but I've heard that it's possible to get an exception if there is a medical necessity. I'm 5'6", 295 pounds, so definitely meet the criteria for surgery, but was wondering if anyone has had experience with getting their insurance to make an exception.
If so, what are the steps? What are my chances? Thanks very much for your help in advance!
Ann
Good luck- I needed orthodic inserts for $400 and my insurance refused to cover those. Even when the foot doctor said it led to many more complications later down the line. They didn't care at ALL.
annk , 01-24-2011 02:50 PM
So, so true! My insurance will pay for blood pressure medication, to treat my sleep apnea and for physical therapy as a result of being obese but won't treat the cause. Insanity.
Typically, the only way you can get an exception is if your employer's health plan is self-funded (more common with smaller companies than large). In these cases, the employer really has a say in what gets covered and what doesn't. Other than that, get super picky about the language used in your policy. Does it exclude treatment for "obesity," or "morbid obesity?" If it only says it excludes treatment for "obesity," then you can appeal because "morbid obesity" is technically a different condition, as it is defined under a separate code.
annk , 01-26-2011 05:58 PM
Thank you both for your responses! I think I'm stuck as my tricky policy very clearly excludes any type of WLS. But, I might go the Mexico route if I determine this is the best thing for me. Seems like there are some very reputable doctors there and that will be way more do-able than trying to foot the bill here!
Thanks again!
Ann
Perhaps you could work out a payment plan?
if you decide to go overseas - and a number of people do it - make sure you line up aftercare HERE before you go. a lot of surgeons don't want to touch another surgeon's work.
