Thread: ins exclusion
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Old 04-10-2007, 05:33 AM   #4 (permalink)
hummingbird5953
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Join Date: Mar 2007
Location: Baltimore, MD
Surgeon: Dr. David von Rueden
Age: 30
Posts: 283
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Raquel,
Have you checked into any legislation that your state may have in regard to bariatric surgery?
I ask because I live in Maryland and, here, there is a mandate saying that even if your insurance company excludes bariatric surgery, they must pay for it if:
1) the insurance company is based in MD
2) the employer is based in MD
3) the employer employs at least 50 employees
4) you meet NIH criteria for surgery (i.e. 35 BMI + 2 co-morbidities or 40 BMI)
I realize that you don't live here but TN may have similar legislation. Start by checking with your bariatric surgeon's office. Mine told me about the legislation and they were prepared to help me seek approval via the state legislation because my old insurance company had a specific exclusion regarding bariatric surgery.
Don't give up yet! That's what the insurance companies want us to do...hear 1 "no", take it as gospel, and give up so they don't have to pay.
Good luck!!!!!!
__________________
Jen
5'9", BMI: 28.5
311/311/193/165?
Highest/Pre-Op/Current/Goal

RNY Surgery date: December 13, 2007

Total pounds lost, to date (9/18/08): 118 lbs.

Onederland is SWEET!!!!
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