Didn't see that coming

I saw the nurse today.  We talked about all the hoops I would have to jump through with my insurance and everything sounded good.  I took my crazy test and went back to work feeling good about everything.  She asked me to call my insurance to see if they would cover the sleep study. this was the point that I was informed by my insurance that the Company I work for opted out of having WLS offered in their plan. The insurance company I'm with offers it... my employer said no.. WTF! so now I'm looking for a new job.  Any ideas where to look for a company that has good insurance? I'm very computer savy I work for a retail chain right now but I do have banking background.  I did not come this far to let my crappy job ruin my goals of a better life. :::Edit::: I went to the site for my insurance and I read over my plan... no where on the plan did it say anything about them not authorizing the surgery so I read into everything and under  "inpatient precertification" that it is in my plan.  so now I think that cow on the phone lied to me! Have any of you have these kinds of issues.. My insurance Company is Cigna.  I know they suck already... but do they suck this much?  And can an employer opt out of something like that?  I mean how can they say "Oh no one in our company is fat so we dont need that"? GAH! so upset and flustered now!

*coughSTARBUCKScough*

LOL

I've heard they are incredible and even cover it for PART-TIME employees!!!

Check it out!

GOOD LUCK!!!!

 

ETA: YES they can do that

your employer can opt out of covering surgery for sure, even if the insurance company covers it.  Read your summary plan description very carefully and look under exclusions for bariatric surgery, weight loss surgery etc.  Also have a look under what needs to be pre certified - usually that's where bariatric surgery is listed...It sounds like your plan has Bariatric surgery listed under pre-certifications.  Which is a good thing If I was you, I'd call the insurance company a few more times and see what kind of answers I get, then see if the person who does the prior authorization at the surgeon's office will call and see if they can get a straight answer.  Above all else, you need to get a "yes this is a covered service" in writing. good luck!

I work for an insurance company and the answer is YES a company can opt out of any coverage for almost anything even though the insurance carrier offers it.   It's kind of like wether or not they cover vision/dental type of thing.   I work for the ins company and our insurance opted out of any bariatric surgery for any reason.   I would definitely call again though and see if you get the same answer.    Not all employees are necessarily good at deciphering benefits.   They are very complicated.    Also read over your policy very very closely.   Let me know if there's anything I can do to help.   I sure hope that person you talked to was wrong.   Good Luck!!

they sure can! The last company I worked for did! and it caused a 4 year delay, they've got two other women there that have been fighting the company and the insurance to cover it for the past 4 years and still no luck. I was pleased as can be when I found out my new company's insurance covered it.

Unfortunately it's true!  I fought with my company for 4 years to include it in their plan.  Unfortunately, I didn't have any co-morbidities so it wasn't medically necessary and thereforemy company could exclude it.  Double check your plan, because if you have co-morbidities it could be considred medically necessary and then they may cover it - I would ask for a written copy of the policy to make sure that you know what's true and is not. FYI...I went to Mexico to have my surgery done becuase my company excluded it.  My experience was fabulous and the cost was $12,500 for the entire thing - flight, hospital, surgery, hotel!  Dr. Joya in Puerto Vallarta did it - it was the only way I could afford the cost (although I also had a friend help me pay for it - I consider her my life saving angel.).  There are ways you can do this - keep your hopes up!

The insurance "policy" that an individual or company purchases from a provider is essentially an ala carte situation. There is a basic plan and then a menu of things you can choose from.  Every employer has to decide how to best spend its available dollars to get the best overall coverage for its employees.  Those dollars make part of your total wage (burden rate) as well as from extra money they charge you.   The employer pays for every type of coverage  they choose from the ala carte menu whether or not it is used.  It's like paying extra for a convertible but it always rains or snows so you never put the top down, yet you paid a premium for it and the car dealer won't give you any money back . Many employers look over the health history of their staff to determine where the greatest needs lie. If only 2% of their staff are morbidly obese, they may not choose to pay for such coverage.  Even if 25% of their staff could be helped by weight loss surgery, but statistics show that on average only 5% of MO people seek WLS, they might not add it to the plan because statistically, they wouldn't be getting mu*****omparison to the cost, or in comparison to offering some other benefit to the greater workforce. Whatever you do, GET THE FACTS IN WRITING.  Telephone conversations can be misleading and misinterpreted. Ann

I also agree about the getting it in writing.

I was told when I first got the particular insurance I have now that it was not covered....but I called again....and again was told NO.....BUT
I called again, asked for a manager and guess what??  Oh MY Policy it IS covered!!!

I've even called back a couple of times since then to confirm LOL

 

good luck