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Does this exclusion include WLS?



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If an insurance says all treatments for obesity are excluded, does that include WLS?

My employer's insurance excludes WLS but specifically says surgery is excluded. I was thinking of getting a supplementary student plan through my university and found this under the list of exclusions:

"For treatment of obesity, regardless of the history or diagnosis, including, but not limited to the following: weight reduction or dietary control programs; prescription or nonprescription drugs or medications such as Vitamins (whether to be taken orally or by injection), minerals, appetite suppressants, or nutritional supplements; and any complications resulting from weight loss treatments or procedures"

Is this yet another WLS exclusion?

I had a glimmer of hope and am wondering if, because WLS is not SPECIFICALLY mentioned like in my other plan, if it could possibly be covered....

thanks, I'm so desperate.

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I think you need to call them and ask. I belive it is probably excluded. Sorry, hope I'm wrong!

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It doesn't mention surgery, so maybe there is hope. The way I read it, it sounds like what they are talking about is stuff like Jenny Craig, Weight Watchers, diet pills, etc. But I would call them and ask.

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I have bc/bs mi ppo, our policy states that it does not cover weight loss or treatment of obesity, ya da ya da yada... but when i called them and gave them the procedure code they said that it is covered as long as it is medically necessary and you follow all of their requirements, ie.. 6 month diet, psyche eval, and such. They said that you had to have a BMI of 35 with 2 co morbids, or 40 BMI with none. Also they said that if you had a BMI of 50 you didn't have to do the diet thing. Anyhow, don't give up hope. Get the Lap Band code and give them that when you call your insurance. That way you will know for sure.

Good Luck.

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    • Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
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        Life as a big person had limited my life to what I knew I could manage to do each day. That was eat. I hadn't anything else to look forward to. So my eating choices were the best I could dream up. I planned the cooking in managable lots in my head and filled my day with and around it.

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