Any one know about HMO insurances cover ?!
Question: do hmo insurances cover Gastric Bypass Surgery?
Answers: do hmo insurances cover Gastric Bypass Surgery?
Most HMO's will do just about anything not to cover this particular procedure. There is usually a long list of hurdles you must jump to get a prior authorization, and that still does not guarantee payment of your claims. Not only do you have to be morbidly obese, but you must also show that you are mentally capable of living with your new body. Supposedly, a good deal of patients become shocked with their new bodies and develop mental problems. This will require quite a few sessions with a counselor who will also touch base on your weight problems and any issues you may have with food. You also have to prove that you have exhausted all other traditional avenues of weight loss like diet and exercise. Again, you or your doctor can't just say you have, you must "prove" it. It is best to contact your insurer and ask for their "clinical review criteria" for this procedure before you proceed. This will tell you exactly what they look for when determining the medical appropriateness of your surgery.
Most HMO's don't, but some will if you are morbidlly obese and have documented evidence that you have exhausted all other treatment options for weight loss.
Here's more info: http://www.obesehelp.net/
This shouldn't be in the Dental section but i'll answer it anyway.
Gastric Bypass Surgery can be covered by HMO if your doctor has proof that if you don't do it, it can put you at high risk for a certain disease and become a hazard to your health.