employer exclusion

When I started looking into WLS in August of 2006, it was covered 90%. My last surgeons visit was in November. They said I had to attend 4 meetings, over 4 months.(couldnt go to 4 in one or 2 months either) and there wasnt one that counted in December. I went to every meeting, I only have one to go after this month. I was so close now my insurance says that my employer has excluded the surgery. I am trying to appeal it by writting letters and my pcp is behind me 100%. Did anyone else have the surgery even though it was excluded? Is there any hope even with it being excluded on the policy. It was effective immediatly.

Wow, I can't believe an employer would think it was an intelligent move to exclude a benefit which would also benefit them so much. I would definately appeal it but it sounds like you're going to have a battle on your hands. Best of luck! Sherri

Who is your insurance with? You could ask your employer if they would check into putting a WLS rider on the plan. If it was excluded at renewel then appealing probably won't help, insurance is so sneaky. Did you inform your employer that you were going through the process before the renewel came up?

I have SIHO insurance. The way it was presented to me, was that there were to many people inquiring about it and the insurance rep presented to my employer that they exclude it, before they had too many claims.it was a done deal that day. The way I understood it is it was about the money they were potienially gone to have to pay out. My employer didnt know I was trying to get the surgery yet, I was waiting til I got the date. I dont know my boss' well enough to talk to them about this, its a situation where I only see them a few times a year. I have written a letter and I am sending it to the insurance co. I was wondering if I should atleast e-mail my boss about this. I'm so frustrated because I was so close.

How sneaky of that insurance company and just plain rude. It doesn't surprise me. Insurance companies are covering a lot of cost for this surgery, but I agree with the other poster above me. . .you'd think they'd send us the information, begging us to have the surgery, so in the end we save them money. . .on the other hand, do we, after all if we don't have it we die a hell of a lot easier and they aren't keeping us on the plans for another 20 or 40 years. . . I wish you luck! I would write the boss and explain everything to him, tell him all about your life and what you are going through, went through and will go through if you don't have this surgery. Good luck. *hugs*