group health insurance

It does depend on your plan....it is very frustrating.  I know the federal employees dont have any problems, state employees I'm not sure.  DSHS does not approve at all, I guess.  Did you self pay for lap band?

I've been on Group Health through 2 different employers, and one covered WLS, and one didn't. Even when it covered WLS, it was only band or RNY, and I wanted a DS, so decided to self pay despite having insurance.

I have noticed while trying to get something approved through GH, it can make a huge difference what doctor sends the referral, as they are sometimes biased about things like WLS, and when you get one that "gets it", they can somehow make that referral more positive. Try a different doctor.

How can I find out which Group Health Plan I have?? I've looked through the paperwork and my husband has looked too to see what plans Boeing offers for insurance and right now is the time we can change if we want to but I don't know what plan to choose if in fact they offer WLS.

It can be so discouraging. I don't know if I have to call Group Health customer service to find out but my feeling is that they probably tell everyone its not covered and I'm going in for a sleep study and a stress test and don't want to raise any red flags should I begin to pursue the topic of WLS with my doctor.
Do you think, even if I don't have the right plan, that if my comorbids are bad enough in their eyes, they will waive the exclusion and maybe I can be approved???

If you do have co-morbs, they definitely do help you get approved for WLS.

I would just call GH and ask them if your covered. They usually just read what applies to you, and it's sometimes hard to understand (probably supposed to be,lol) so make sure they clarify anything you are unsure of.

I'm sorry you're having such a hard time, but I think it may be a good thing that your insurance is through Boeing. I've had family members that did/do work for Boeing, and they have pretty good benefits.

Like a previous poster, I  have had GH for a couple of years through my employer.  First year the plan did not cover WLS. Second year it did. Process for me was pretty easy, organized, and quick by comparrison.  Like pixiestix, I had Dr. Landers for my Lap-RNY, at Overlake.

From my first inquiry to my PA at Port Orchard GH, it was 6 months to surgery.

GH and Overlake are working on accrediation as a Bariatric Center of Excellence. Therefore, it would not surprise me if appeals were processed and approved if there are co-morbidities.  You can ask GH to send you your paperback booklet of coverages. It will show if WLS is covered.

Best of luck, and if you wanna chat more about it, feel free to pm me. 

Thanks for your reply.  I appreciate it.  I hear so many wonderful things about Dr. Landers and Overlake.  I called and I do have coverage for WLS.  I am going through sleep apnea test right now.  I have so many "issues" but none are considered comorbities.  If my sleep test comes back negative for sleep apnea....I am pretty much out of luck getting insurance to cover.  I am soo stressed about it.  I really do not want to have to self pay.  That is so expensive.  We pay such huge premimums for insurance and I have been dealing with so many different things it should be covered.  The list of comorbities is short and vague.  UNFAIR!  Wish me luck! 

I have minor comorbities and I was approved.. but if you are denied.. you can appeal!  Show them that the health issues bec of weight will cost more in the long run than the RNY in the future.

 

 

The ARNP I am working with said she can't submit the referral if I don't have one of the listed comorbs.????  If my sleep test comes back negative for apnea then I might talk to another Doc, if she won't do it.  I will appeal as well if I have to.  Thanks!

Yippeee on the WLS coverage. My co-morbids were very minor, in fact I was surprised I was approved. My blood pressure was borderline high, sleep apnea was there, and high cholesterol. That was it. No diabetes, heart conditinos, thyroid conditions, nothing. So, hopefully you will be approved!!

Keep me posted!
Kathy

To the GH folks that were approved, what did you use to show you failed all other diets?! I cant get approved by them! I have several co-mo...I think they find ways to say no.