I emailed my insurance provider around 4am, and they replied this afternoon (I <3 them for their quick response!):
The following gastric restrictive procedures: gastric bypass using a
short Roux-en-Y anastomosis (less than 150 cm), vertical banded
gastroplasty, gastric stapling, or adjustable lap banded gastroplasty
may be considered medically necessary and appropriate for treatment of
morbid obesity.
Your policy does provide benefits for eligible surgical expenses when
determined to be medically necessary. [Blah blah blah, insurance talk about deductibles and such.]
Your policy requires preauthorization for these types of surgical
procedures. This means that your provider will need to contact our
Clinical Management department prior to the surgery and your inpatient
admission. Clinical Management will determine whether the service is
medically necessary.
I wanted to cry in relief when I read that letter. It does echo most of what the woman I spoke to on the phone with last fall said to me. It’s good to see it reaffirmed in writing!
And I definitely meet the “medically necessary” criteria, particularly in regards to having a BMI of over 40 (48-49) AND being 100 lbs. or more overweight (my ideal weight is 121 lbs. – 155 lbs. and I’m currently 309 lbs. You do the math!).
Excuse me while I float off on my cloud…
In la weight loss is getting quite popular, particularly the use of didrex. People are preferring hydroxycut in favour of going on a stressful diabetic diet.
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9 Comments
Can you please e-mail me at RegrettedTragedy@aim.com
I would like to ask you a few questions. Thank you very much.
what state do you live in, do they make you wait six months of weight appts.
Caroline, I live in PA, and yes, I must follow through with monthly meetings/weigh-ins for six months.
I’m so glad they will approve it for you! I’m so confused as far as money, timing, insurance, etc. I just changed jobs and have BCBS starting in 2 days, and I’m going to an orientation type thing at a local Bariatric center in November. I’m 120+ over weight, and I imagine my BMI is over 40. I guess I have high blood pressure and borderline type 2 diabetes as well, including 10 years of trying everything else under the sun. Think good thoughts for me as I try and get approved in the next few months, and GOOD LUCK!
hello my name is cassandra im happy for u. i have blue cross and bleu shield i called them and they explained everything so fast i really dont know what she was talking about. But my deductiable is 2000 i was woundering how much do i have to pay out of pocket.
- I have BCBS in NJ and I am told Im covered but I cant find a HMO DR? Any suggestions?
When you say follow through with six months of weigh ins is that before or after the surgery ? Also is there anything you have to do before the surgery like see a dietitian for 3 months, see a shrink, or and multidisciplinary plan you have to complete before approval ?
I was wanting to find out if my insurance covers this, I cant find it in the book and I have tried calling but there wait times are forever my carrier is Blue cross anthem WI
What insurance do you have? I am considering the same procdure.