Lets Stop Feeding the Rumour Fire...

Hi everyone, I mean this with the utmost respect, because believe me, been there, done that... Every year there are countless posts stating that insurance companies are going to stop covering WLS, regardless of an individuals comorbidities, the company they work for, etc. Unfortunately, in MOST cases, this is not the case. In MOST instances, it is YOUR employer who is telling an insurance company what they are allowing coverage for. It is not the insurance company but your employer who are deny you coverage. In some cases you can appeal to your company to waive their written exclusion, but for most it's an unfair battle. I just hate to see post-ops worry unnecessarily when it's already an incredibly stressful time. I know I chew enough fingernails when I was going through the process... And no, I don't work for an insurance company... Best of luck to all the pre-op's, may your place of employment be smart enough to realize their could be saving a valued member of their staff's life. And to all the post-ops...keep up the good work!! Peace to all, -Deb

Deb, I can't agree enough. There are always exceptions but for the most part you are RIGHT ON!!!!!!!!!!!! And I don't get any kick backs either, darn it!

Yep, you are 100% correct. It's not the insurance company that chooses the coverage, it's the employer. The employer purchases a plan and adds any riders onto the plan they so choose. By adding riders, that does not mean they are ADDING something on to the coverage, it can also mean they are taking away! And yes, I used to work for Health Net, and I've seen first hand what companies choose to purchase. Thanks Deb -- we all need a reality check! Tara

Well................ kinda. The insurance companies determine what they will cover as a baseline for coverage. It sounds like WLS would not be included in that portion of the policy. What they offer to employers are riders which allow them to specifically cover certain aspects of healthcare. For example,Acme Insurance Company could issue a rider to a company which would allow for coverage of WLS provided they "X", "X" being some kind of specific requirement. They could then issue yet anoither rider would allow the company to exclude the specific requirement for that aspect of health care. Acme Insurance Company seems so appropriate. Isn't that the one that Wiley Coyote used when he was after Road Runner??? Peter

*Beep* *Beep* Can't beat the classics! You are so funny! Sher'

Don't companies stop paying for coverage of some procedures in their employees' policy because of the $$$$$$ the Insurance comapny charges to keep it in? ( The cost of the riders?). Surgeons are telling their patients that they are being given a heads up directly from Insurance companies...that is fact..not rumour. I called my company directly and they will not be covering WLS after July! Straight from the horses mouth...it may have been rumor and conjecture in previous years...but as WLS is being requested now in almost faddish porportions...I feel there is a move on to keep a ceiling on costs to employers AND insurance companies. Insurance (of all kinds) is nothing but a necessary evil IMO. Sher'

I don t understand because if we did not have this surgery then we will end up with pile of pills, don't feel good and alot of trips to see doctors in their office. This surgery saved $$$$$ for pills and doctor trips. It is about the money they care and don't care about people's healths until they are in our shoes and will get wake up call. I am so disappointment all of this and My heart goes out for pre op people and wish we have more power to help them to get covered by insurance. Kathy K

I work for Aetna... and they are not covering WLS effective 1/1/2005. I was told by a coverage rep that if I didnt have it done in 2004, then it would not be covered. Now, I am not 100% positive if there are exceptions but it sure did not sound like it to me. I even asked the rep "you mean that even though I went through all of the preliminary exams and visits in 2004 while it was covered, it wont be an eligible procedure in 2005" and she said... "If it incurrs in 2005, it will not be considered". I was fortunate enough to get in before the end of the year but if I hadn't... I would have fought tooth and nail because it isn't right. Beckie

My SURGEON has been telling prospective patients that a lot of insurance companies are stopping coverage. Why would he be saying it when he knows that information will DETER his future patients?

Hi everyone, I'm not trying to stir up controversy, but I think it's unfair to cause unnecessary fear when as I mentioned, this is already a scary enough time. I did say in my first post that this was the case in MOST situations, but not all. In the three years I have been an member of this site these same questions come up year after year, with Dr's telling their patients that certain insurance companies will no longer be carrying WLS, or whatever, and always when it's insurance renewal time. So please, just remember my Aetna is not your Aetna, and many will continue coverage. They might make it more difficult to qualify, but thats another post alltogether. Just lookin out for the little guy!