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    kdsmith's Avatar
    kdsmith Posts: 1, Reputation: 1
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    #1

    Jun 11, 2008, 12:16 AM
    Exclusion in policy
    My health insurance has an exclusion for weight loss surgery and any complications of such procedures. Seven years after my weight loss surgery I have developed a grossly large stomach pouch (500 cc compared to 30 cc) It has not affected my weight loss as my surgery was successful. However, it does cause reflux and I have chronic burping and belching almost constantly. I have test that prove this diagnosis.

    The surgeon I was referred to is a pioneer in weight loss surgery and he told me it is a medically necessary operation. What do you think my chances are of getting an approval from my insurance company. The surgeon is out of network but I am willing to pay the $6,000 deductible and 20% copay. They do not have anyone in network who is experienced in this type of revision that I would risk my life to save a few thousand dollars.
    tickle's Avatar
    tickle Posts: 23,796, Reputation: 2674
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    #2

    Jun 11, 2008, 03:04 AM
    What you apparently have is a complication of weight loss surgery and as you say, your policy excludes complications. What makes you think they will reverse their policy exclusions?
    Fr_Chuck's Avatar
    Fr_Chuck Posts: 81,301, Reputation: 7692
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    #3

    Jun 11, 2008, 05:22 AM
    If in the medical notes, anywhere, it shows this is caused by the weight loss, then it will not be covered.

    Also you should submit this for pre approval, to be sure
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