Hi Jennifer....

I looked up the plans you listed as best as I could.  Insurance jargon is always confusing to me.

The best that I can tell is that while both plans say they do not cover services for the treatment of obesity or morbid obesity, it does not define weight loss surgery.

I am a Washington State Employee.  When WLS was excluded on our plans it was very specifically defined....It identified WLS, it defined that it did not matter if it was considered medically necessary or life threatening.  Insurance jargon was very careful to be as all inclusive as possible to ensure no surgeries get approved.  I just don't see that on your plans.

I know you said you talked to someone, but who?  If you called the plans, all you got was a customer service rep.  I speak from a lot of experience...hang up the phone and call 5 more times and you're more than likely to get at least 3 more different answers.

I would highly suggest that you call your human resource person and ask specifically if it is covered and if they either don't know or say no, I would ask who would know or please refer me to the section in the handbook that labels this.  Do a lot of research and have your ducks in a row. 

If it truly is an exclusion, there will be no getting around it.  But it may be that if it is deemed "medically necessary" and insurance companies have their own definitions for that term, it may indeed be covered.

I still have a gut feeling that it is covered.  State employees and school employees generally have the same coverage...from what I've heard, I think school employees actually have it a little better...I may be mis-informed....

Have you thought about where you want to have surgery?  Are you planning on going through Oregon Weight Loss or OSHU?  Both have insurance reps in their programs that can also give you a wealth of information.  You don't have to wait until the seminar to find out.

Definitely, if it is covered, you will be required to go to a "Center of Excellence".

My experience from the past is that if WLS is an exclusion, then any services needed to be approved (ie. sleep study, labs, psych. eval, and including complications that may arise from the result of the surgery) will not be covered.

Some of it, you may be able to get around if you have a suppportive doctor.  Things like labs and sleep study I would request and not necessarily volunteer that it is needed as a pre-requisite for surgery.

If you don't have a primary care physician and are leaning towards Providence, I would highly recommend Dr. Robert Wells.  He is very kind, and very supportive of WLS.  He will do what he can to help.

Sorry so long winded....I'm a social worker by profession...so that kind of kicked in.   Also, mine has been a long and somewhat painful journey...so I try to share what I have learned along the way to cut out some unnecessary pain for someone else.

tk