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Gastric Bypass and Your Insurance, page 8
A 12-page report about gastric bypass and your health insurance
©2005 Jonni Good
Many policies exclude gastric bypass surgery.
The procedure itself is expensive, and less expensive lifestyle changes and treatments are available. In addition, the frequent complications and risks of the surgery add to the cost.
Insurance companies first began excluding the diagnosis of obesity in their contracts before bariatric surgery became available. This happened in part because of the proliferation of “weight loss clinics” in the 50’s and 60’s, which were run by doctors who were little more than drug pushers making a fortune by selling addictive amphetamines to their patients. The insurance companies attempted to isolate the bad clinics from the good ones, but the bad clinics kept finding new ways to file fraudulent claims. In the end, the diagnosis of obesity became a common contract exclusion.
Please note - it is important to read your policy carefully. An exclusion of “weight loss treatment” is not the same as an exclusion fro the diagnosis of obesity, or for gastric bypass surgery. It’s possible that weight loss surgery is covered, but weight loss pills are not. Again, read your contract carefully. If the benefit booklet isn’t clear, you may need to ask an attorney to help you figure out what’s covered, and what is not.
When a policy lists a condition, treatment or medication as a contract exclusion, the company has no obligation to pay for it. They are also not obligated to pay for any complications that may arise from the excluded treatment or procedure. This is true even if the complication is life-threatening. In addition, if your surgery was excluded, but some claims related to the surgery were paid by your insurance company in error, they will most likely request a refund for these payments. It’s important to talk to your doctor so you understand what complications may possibly arise, and how much they might cost.
“Medical necessity” is not an issue with a contract exclusion. If the contract does not cover a specific treatment, it doesn’t matter if your doctor thinks you need the treatment, because your premiums are not paying for the benefit.
If your policy has a contract exclusion for gastric bypass surgery but
your doctor is convinced that it is needed to save your life, it may be
worthwhile to contact an attorney who is familiar with the insurance laws
in your state. There may be appeal processes or rights in your state that
can overcome the contract exclusion. Only an attorney who has experience
in this area of insurance law will know for sure.
Next Page of Gastic Bypass and Your Insurance Report
- Gastric Bypass & Insurance
- Understanding Your Insurance
- Prepare for Mistakes
- Insurance Regulations
- Health Insurance Customers
- Pre-Paid Health Care
- "Contract Exclusion"
- "Contract Exclusion," cont.
- "Medical Necessity"
- "Pre-authorization"
- "Grievance or Appeal Rights"
- Summary
New research shows that low-calorie diets can cause food obsessions and binge eating. They can even make sugar addiction worse. No wonder most people end up fatter than they started when they try to lose weight with a low-calorie diet.
The answer? The New Craving Control Diet.
Lose 3 to 5 pounds a week without surgery, starvation diets or dangerous appetite suppressant pills. Enjoy the satisfying, delicious diet that controls your appetite naturally, reduces food cravings, and helps burn fat faster.
Finally - Fitness Without Pain:
Have
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It's called the "Runner's Yoga" program, but it's definitely not just for runners.
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And all without any pain at all. In fact, it can even help reduce pain if you now suffer from injured knees or joints.
To learn more about this new fitness yoga program, click here.
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