Center For Medical Weight Loss Management
Could anyone with health insurance experience explain to me what this means? Please only serious answers.?
Medical and surgical services, initial and repeat, intended for the treatment or control of obesity. However, treatment of clinically severe obesity, as defined by the body mass index (BMI) classifications of the National Heart, Lung and Blood Institute (NHLBI) guideline is covered only at approved centers f the services are demonstrated, through existing peer-reviewed, evidence-based, scientific literature and scientifically based guidelines, to be safe and effective for treatment of the condition. Clinically severe obesity is defined by the NHLBI as a BMI of 40 or greater without comorbidities, or 35–39 with comorbidities. The following are specifically excluded: medical and surgical services to alter appearances or physical changes that are the result of any surgery performed for the management of obesity or clinically severe (morbid) obesity; and weight loss programs or treatments, whether prescribed or recommended by a physician or under medical supervision
pretty much means they will cover gastric bypass surgery if you meet the guideline …pretty much by body mass….but it also means they are not going to cover surgery to remove excess skin etc…..this is another one of those cases where somebody is 30 lbs overweight and they have abused the system so it makes it extremely hard for people who need this surgery have to jump thru hoops to get it
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