Insurance Coverage dependent upon employer??????

Hello,  This is my very first post.  I just attended an information seminar last night put on by Oregon Weight Loss Surgeon Dr. Jay Jan.  It was great!  Very informative.   I have a question though that wasn't addressed.  I don't recall if I heard this at the presentation or read it, but somehow it came to my attention that insurance coverage depends more upon your employer than the actual insurance carrier.  What does this mean?  I did a little research online about my insurance coverage and whether they have covered any of the weight loss procedures before.  I have Regence Blue Cross Blue Shield of Oregon.  My coverage specifically states: "Exclusions:  Treatment for Obesity or Weight Control:  Surgery or treatment (including any later complications), even if you or your enrolled dependent has other medical conditions related to or caused by obesity.  Specifically excluded are:  gastric stapling or bypass procedures, weight loss programs, counseling, hypnosis, biofeedback, neurolinguistic programming, guided imagery, and other forms of relaxation training as well as subliminal suggestion used to modify eating behavior." Then, I found the Public Employee's Benefit Board information for the State of Oregon.  They are also covered under Regence Blue Cross Blue Shield of Oregon.  Their coverage states "The plan will only cover the Roux-en-Y gastric bypass for the treatment of morbid obesity," Why is it that state employees covered by RBCBSO would have this procedure covered, but not necessarily employees of my company? 

Your employer selects from a menu of available benefits in order to get a plan for you that they can afford or think that you will be willing to pay your share of.  You need to let your human resources department know that you want WLS coverage in your insurance.  I work for the State of Oregon, and have BCBS and PEBB now covers both RNY and the lap band.  There are a lot of requirements that go along with that.  If you are Federal Employee and have BCBS, the requirements are a lot easier to fulfill.  So, you see, it does depend on employer.  Start working on the HR people, or you'll have to self pay. Linda

Yep.  Kinda like some people have vision coverage and others don't.  And how much will be paid for whatever (like prescriptions...). I'm lucky because my husband works in Oregon but had BC/BS of Pennsylvania because that's where his company contracted their insurance through.  Why am I lucky?  Because, when I had my surgery in 2005, Regence of Oregon flat-out refused ALL weight loss surgeries and didn't offer the rider to any employer (at least that's my understanding). The statement you provided is the absolute "no" on coverage for WLS.  Talk to your employer and see if they are willing or able to purchase the WLS rider. Lori