I can't get approval

Good Afternoon, I am just starting my weight lost journey, I was referred by my doctor for weight lose surgery. I called my insurance and they stated that that they don't cover it because my job has an small company plan. I asked them even if it is medically neccessary. They stated yes, it won't be covered. Can any one give me some direction on this issue! I don't know what steps to take next or should I just give up.

Teisha, Check with the person/people with your employer who are responsible for the employee health benefits. If, as in many cases, their benefits plans are on a calendar year basis, they may be in the process of obtaining bids for next year's benefits, and they, or their broker, may be able to seek health plans which will agree to sell the special rider required for small business health plans that cover WLS. Not all health insurance companies will agree to sell the rider, but some do. From anecdotal experience (and this may have changed), traditionally, Blue Cross/Blue Shield (CareFirst) has refused to sell the rider for the small business health plan. However, I have heard of instances where MAMSI (at least before being acquired by United Health) was agreeable to selling the special rider. Kaiser also has some plans (but I don't know if they will sell to small businesses) that provide for WLS surgery. Hope these ideas help. Leesa

I understand your dilemma. I, too, was denied the surgery as a result of insurance issues. I am insured through my husband's union and they will not cover the WLS either. I gave up and started the traditional way --- but, hey I've lost 40 pounds since March. Gee, only 140 pounds to go! Let me know if you are successful in your challenge. Good luck!

Teisha, I had the same problem you did. I had BCBS which (in my case) was managed NCAS. Unfortunately, small policies owned by employers are not required to follow state law and can not be reported to the insurance commish; they are only required to follow federal law, which does not require coverage for WLS (UNDER ANY CIR****TANCE). BUT, if your employer offers the choice of another policy, see if you chan switch. All HMOs, in the state of MD, are required to cover WLS IF MEDICALLY NESICARRY-IT'S STATE LAW. Unfortunately in your case, if REALLY want to fight it, the only thing you can do is hire a lawyer and sue them-Good luck-I don't of many that have won in court. Unfortunately, federal law protects them! Samantha