chanou

Yes I am medically qualified- My BMI is 46, I have PCOS and diabetes. I did called and a rep told me that baraitric surgery was an exclusion in my contract- Then i started doing my research and reread the the certificate and found that clause under the covered benefits. I am concerned because under exclusions, it says that it excluded treament of obesity yet the above clause was in the covered benefits- It's like they are contradicting each other.

Can someone tell me if that means that I won't covered for the laopband- I just went to my seminar yesterday?? Thanks This what is under my covered benefits in my certificate booklet Obesity Covered Services for obesity include up to two nutritional counseling visits when referred by your Primary Care Physician. Prescription Drugs and any other services or supplies for the treatment of obesity are not covered. Surgical treatment of obesity is only covered for patients meeting Medical Necessity criteria, as defined by us. Precertification is required, and coverage is only provided for gastric bypass or vertically banded gastroplasty. and then under exclusions and what's not covered: Any services or supplies for the treatment of obesity, including but not limited to, weight reduction, medical care or Prescription drugs, or dietary control (except as related to covered nutritional counseling). Nutritional supplements; services, supplies and/or nutritional sustenance products (food) related to enteral feeding except when it’s the sole means of nutrition. food supplements. Services for Inpatient treatment of bulimia, anorexia or other eating disorders which consist primarily of behavior modification, diet and weight monitoring and education. Any services or supplies that involve weight reduction as the main method of treatment, including medical, psychiatric care or counseling. Weight loss programs, nutritional supplements, appetite suppressants, and supplies of a similar nature. Procedures including but not limited to liposuction, gastric balloons, jejunal bypasses, and wiring of the jaw.