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obesitysurgerysupport2 · Obesity Surgery Support - We serve people having had Bariatric Surgery
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About Insurance (pls delete if this topic is boring to you or you c   Message List  
Reply | Forward Message #440 of 932 |
Dear all,
I thank you so much for the messages, it has been such a help to me.

The problem I have right now is that my insurance company have some
criteria I need to fulfil to get funding for a gastric band operation.
They treat acute conditions, but consider obesity a chronic
condition. They will fund me if I have other co-morbidities or other
symptoms but at the moment I donīt.

They have requested a medical report, and this is the bit I am not
understanding very well...

"the reason that we have requested a medical report is because, as you
point out, this does seem to be treatment to cure an acute condition,
however it would be unusual to authorise bariatric surgery, so we need
to refer this to our specialist medical team. We need the information
requested to check whether the treatment can first be considered, to
check whether this meets our definition of an acute condition, whether
the treatment is appropriately recognised as beneficial to your
condition by the relevant medical bodies (I.E. not experimental), and
whether the condition being treated was not present before you joined
us (by onset date we mean the original date that you first noticed
your symptoms, even if this is an approximate date).

We do not pay for any treatment which is specifically to treat obesity
and nothing else - We treat every case individually, and please be
assured that we look very carefully into whether the treatment
required would qualify for benefit, but as this is an unusual case
these are the most specific guidelines I can give - my advice is to
have your doctor include as much information as possible about your
conditions and why this surgery is recommended."

So...I have a doctor who will write a medical report so that I am able
to get surgery, but what on EARTH do I do? Do I have to make up non
existent problems like hypertension or diabetes or goodness knows what
to get treatment for obesity which for me is an illness iīve battled
with since I could walk...

Has anyone else come up against these criteria, or these kinds of
problems, and how did you get round it??? My doctor isnīt the problem,
he will write any thing on the report, itīs just that I have to tell
him what to write so that it shows I fulfil the criteria for my
insurance company...it is a bizarre state of affairs I know...

What next??? Hugely confused, thanks for taking time to read this far....

Kindest regards

Lulu






Tue Jan 31, 2006 10:51 pm

lululoves2005
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Message #440 of 932 |
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Dear all, I thank you so much for the messages, it has been such a help to me. The problem I have right now is that my insurance company have some criteria I...
Lulu
lululoves2005
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Jan 31, 2006
10:52 pm
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