Insurance Help!?!?!
My insurance doesn't cover any weight loss related treatment ... or treatment for obesity. In fact, nearly all insurances don't. But that's completely different than paying for bariatric surgery. Because bariatric surgery is not an obesity treatment. It's a treatment for our co-morbidities such as heart disease, diabetes, hypertension, sleep apnea, etc.
You need to find out if your policy has a specific "exclusion" for bariatric surgery. That means that there is language within your policy that states that surgery is not covered because it has been excluded by your employer or when their contract was negotiated with the insurance company.
To find out if you have an exclusion you need to find out what the procedure code is for the surgery you want. Call your surgeon's office and ask them for that number, then call your insurance company and ask: "What is the criteria for approval for procedure #xxx." They'll either give you the list or they'll say there's an exclusion. Then once they give you that list of criteria, ask them to mail you a hard copy (this will be your checklist to get things done.)
IF there really is an exclusion, then get that portion of the policy in writing too. Then take that to your HR director and ask for help. It's not the insurance company who decides if there's an exclusion or not, it's your employer. So then the fight begins to get them to include bariatric surgery in their next year's policy. If you have to go that route, come back and I'll give you some ammo to do that the right way.
Good luck
Pam
You need to find out if your policy has a specific "exclusion" for bariatric surgery. That means that there is language within your policy that states that surgery is not covered because it has been excluded by your employer or when their contract was negotiated with the insurance company.
To find out if you have an exclusion you need to find out what the procedure code is for the surgery you want. Call your surgeon's office and ask them for that number, then call your insurance company and ask: "What is the criteria for approval for procedure #xxx." They'll either give you the list or they'll say there's an exclusion. Then once they give you that list of criteria, ask them to mail you a hard copy (this will be your checklist to get things done.)
IF there really is an exclusion, then get that portion of the policy in writing too. Then take that to your HR director and ask for help. It's not the insurance company who decides if there's an exclusion or not, it's your employer. So then the fight begins to get them to include bariatric surgery in their next year's policy. If you have to go that route, come back and I'll give you some ammo to do that the right way.
Good luck
Pam
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The scale can measure the weight of my body but never my worth as a woman. ~Lysa TerKeurst author of Made to Crave
Just throwing my two cents in on top of the great info. Pam has already given you:
I have BCBSM PPO and they also will not cover any obesity related treatment. I went to my PCP to talk about diet and weight loss options and to weigh in. Once we saw that those visits were not being paid for, she started to code the visits differently. For instance, I would go in for a cold, and she would weigh me and talk about diet, etc. Just a sneaky way to get to see her but have the visit paid for. So when it came time for me to talk to the surgery dept. at U of M, I had no "official" weight loss attempt visits to my PCP. She was kind enough to call over to the bari surg program for me, and also write a letter stating that she did weigh me and we discussed diet and exercise at ALL of our visits. It was good enough for the program.
This may not apply to you, but I just wanted to let you know that if you have to have supervised weight loss attempts with your PCP that those will not be covered, but there are creative ways around it.
I have BCBSM PPO and they also will not cover any obesity related treatment. I went to my PCP to talk about diet and weight loss options and to weigh in. Once we saw that those visits were not being paid for, she started to code the visits differently. For instance, I would go in for a cold, and she would weigh me and talk about diet, etc. Just a sneaky way to get to see her but have the visit paid for. So when it came time for me to talk to the surgery dept. at U of M, I had no "official" weight loss attempt visits to my PCP. She was kind enough to call over to the bari surg program for me, and also write a letter stating that she did weigh me and we discussed diet and exercise at ALL of our visits. It was good enough for the program.
This may not apply to you, but I just wanted to let you know that if you have to have supervised weight loss attempts with your PCP that those will not be covered, but there are creative ways around it.
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