Out-of-stater w/ a ? for a friend...

If an insurance vendor says that WLS is not allowed in any policy in the state of Florida except for State and Federal employees, would you agree? Or have some of you--who do NOT have State or Federal employees' coverage--had wls covered by your Florida-based insurance? Thanks, Sue

Hi Sue,

Let me guess - BCBS of Florida?

BCBS of Florida stopped providing coverage for WLS as of January 2005. They cited "safety" as the reason. But I won't get on my soapbox today on *that* topic. It is allowed on most state and federal employee plans because those are self-insured, meaning that the employers control the benefits - not the insurance company. The insurance company merely administers the program for the company.

I had to file a lawsuit against my insurance company before they finally agreed to pay. I had a benefit for surgery and had met all of the pre-determination requirements. They were just trying to make me quit (or die in the process), IMHO.

I hope this helps.

Kristen

Holy Cow! I guess I am lucky that my company's headquarters are in North Carolina because I have BCBS of North Carolina. I always thought is was strange that we didn't have BCBS of Florida, seeing how we live here, but now I am so glad!

Jan is right, companies can purchase a rider for coverage but not done often enough, IMHO.

I would tend to agree with Kristen that the insurance vendor was speaking of BCBS policies, but some larger companies may have purchased the rider allowing it, the State and Federal policies still allow it and Florida companies that have BCBS plans based out of state may allow it.  Each policy is different and have to be checked thoroughly for coverage.

Thank you.  I have shared your answers. (But others are welcome if anyone else has something to add.)  ;-D Sue

I have BCBS of FL as well. The policy at the forefront clearly and in bold freaking letters states they absolutely don't cover WLS, yada, yada, yada..... because of increased popularity and whatever.  I will tell you that this same policy, buried deep within and I really had to search their online site as well....this same policy does state that "the exceptions are cases of medical necessity based on the following five criteria" and then they go on to list the stuff that any other company would list such as BMI, psych eval, and so forth.  I am not a state or federal employee. My letter was submitted May 24th and we had an answer on May 30th (after a 4day weekend). No hassle whatsoever.   I initially did call BCBS and gave them my contract number to see if they covered it and I had my answer within minutes. Hope this helps.

I have BCBSFL,as well. When I started checking into WLS.my first call was to insurance company. Of course they told me no it wasn't covered. When I asked about medically necassary (sp) they told me anything dealing with weight was not covered in my policy. Talk about being mad. I am having to go a different rout as far as paying. Should hear something soon.

Do doulble check your policy and speak with an agent from you insurance carrier. Good Luck.