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| *Business questions>>>Insurance Questions |
What insurance covers gastric bypass surgery? |
Question: I called my insurance company and they said they would not cover it. I was told there were ways around this but how? Does anyone know of an insurance company that will cover it. I live in VA. Answer: When your health is on the line, don't take a Customer Service Rep's word for it. Check the "Exclusions" section of the policy or Certificate of Insurance. If the surgery is excluded, there's nothing you can do, even if it's medically necessary. However, if it's a covered benefit, it'll be listed under "Covered Services;" if the surgery is medically necessary, it's covered by your insurer. Sometimes insurers turn down preauthorization requests for this surgery because they deem it not medically necessary. This can be appealed by your doctor; if the insurer upholds its denial, it can be appealed to the VA Insurance Department. If you decide to get a job with a large employer in MD that offers a fully insured plan, it's a mandated benefit. That means the insurer MUST cover it, so long as it's medically necessary. I hope this helps. If you need more information, please send me a message through YA. |
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