crushed

 I'm new here, actually new this entire board.  I had been for the past few years contemplating  getting the band done and up until recently was still go for it.

Then I discovered the sleeve and I was sold.  I had found a doctor and was going to sign up for one of his mandatory seminars for next week when I took a major blow to my hopes and dreams.

My husbands employer has BCBS of Alabama and I had looked at their policies to make sure what they required for consideration of WLS.  Then I got on here and noticed someone had mentioned something about their insurance provider having exclusion clauses.  If I didn't immediately whip out our benefit booklet to find it.

There is was on one of the last pages:

"Services or expenses for treatment of any condition including, but not limited to, obesity, diabetes, or heart disease, which is based upon weight reduction or dietary control or services or expenses of any kind to treat obesity, weight reduction or dietary control. This exclusion includes bariatric surgery and gastric restrictive procedures and any complications arising from bariatric surgery and gastric restrictive procedures"

I'm crushed.  Without help from insurance I don't think we could afford it.  We're in the process of digging ourselves out of debt so our credit isn't all that fabulous.

I could literally just cry and cry.  Here I had thought I had found the answer to my prayers only to have it taken from me.

 Yeah, unfortunately many employers exclude it. Probably because it's an expensive add-on to their insurance. Sadly, there is no way to appeal it if they declined to include it in their coverage. :(

I am so sorry for you.  My sister wanted surgery for 5 years before she was able to have it.  Hang  in there,

Are you reading that in context? Is there a weight loss surgery section anywhere in your policy? I'm only asking because this type of statement appears in my policy towards the end section of exclusions but specifies unless otherwise stated in this document (something like that), so I searched and found the section where it's covered. Hope this is also the case for you.

I've heard that you can get the sleeve in Mexico and they have several excellent doctors there.  From what I've read, the cost is about $5000.  Maybe you can set a goal to save for that or possibly take a loan from relatives or the bank once you've gotten your credit back on track?  And also keep in mind that insurance companies are constantly changing what they will cover so it's not out of the question that they will some day cover bariatric surgery.  I have BCBS and they covered my sleeve.  I'm sorry you feel so crushed;  try to remain hopeful.  Hugs.

Faith

The spiteful ******* in me thinks you should prove to them how WLS surgery could be the cheaper way out, and go to the doctor for weight related issues ALL the time. Go get screened for diabetes, sore knees, sore ankles, sore back, high blood pressure, shortness of breath, etc etc etc. Call and tell them the weight is causing you problems, and you've tried dieting and more traditional WL methods and they aren't working. maybe they will come out of their ancient cave and see the light.

I love a spiteful ******* ... when it's well-placed spite LOL .... but this isn't on the insurance company, it's on her employer.  Most likely the insurance company itself DOES cover bariatric treatment, but her employer chose to specifically exclude it from their plan because it costs more in premiums.  I waited for 3 years for my former assho--I mean, employer, to change our policy and talked to his wife about it (she had as much power as he did) but she's a "nutritionist" so of course nothing changed.  

Anyway, the blame is on her employer, not the insurance company... they can only cover what they're paid to cover.

I agree it is on the employer and not the insurance company. I was in the same situation. I work for a large county agency and while Cigna (our insurance carrier) does cover WLS it is specifically excluded from the policy my employer purchased from Cigna. While I was not a happy camper about this I sort of understood how it came to be. I am not all that sure given the cost of covering ALL employees for health coverage and how little each employee pays for their part of health coverage  it would have been "fair" for everyone's cost share to go up so that WLS could be a covered benefit. I do understand the cost savings related to diabetes, heart issues etc and I did consider all of that before posting this and that is still my humble opinion.
Yes it sucked to self pay. Yes I was blessed in that I own a home and was able to take out an equity line of credit to cover the surgery. Yes I know that not everyone is able to do that. Yes I know that not everyone is comfortable going to Mexico for surgery although it is a very viable option and one I would recommend.
Again before folks start flaming insurance companies and employers I just wanted to present a different point of view from someone who has "been there done that".

 I understand where the company is coming from because of how few people that it might have actually benefited.  I wish we owned our own home but unfortunately due to past bad choices we made that isn't possible right now.

I'm not mad at his employer,  I should have seen it coming to be honest but I thought for once that luck would have been on my side.

I appreciate your "humble opinion" as you put it 

It wouldn't hurt to call them and see if the cover it.  Insurance policies change all the time and if your handbook is old, it could have changed.  I thought I couldn't have WLS for years because my handbook says the same thing.  Then a coworker had the sleeve and as I was talking to her I asked if she had it covered by our insurance and she said yes!  Not only did I find the perfect surgery, but my insurance was going to cover it. Again, wouldn't hurt to just check into it.