PLEASE HELP!! ADVICE ON MEDICAL APPROVAL

HI. I WAS INFORMED BY THE WEIGHT LOSS SURGEON IN MY AREA THAT MY INSURANCE (PREMERA BLUE CROSS) DOES PAY FOR THE SURGERY... BUT MY PLACE OF EMPLOYMENT WILL NOT PAY FOR IT .. IT IS AN EXCLUSION IN THE PLAN THAT THEY OPTED OUT OF... I AM HEART BROKEN.. HAS ANYONE HAD A SIMILAR EXPERIENCE? IF SO COULD YOU GIVE ME ADVICE ON HOW TO FIGHT THIS.. I WOULD APPRECIATE IT SO MUCH. THANKS.. CATHERINE

Sorry you are disappointed. When I was with Premera they also had an exclusion for bariatric surgery and there was no way around it. Is there a way to switch insurance policies at your workplace to a more friendly insurance? It makes me so mad that the insurers all have $20,000 policies for drug and alcohol abuse which can be used every two years, but not for a permanent weight loss tool. Mari

don't give up, you can atleast look into an appeal, even look at hiring an attorney that specializes in this. the insurance companies want you to give up and go away, let them know you won't!!! did you know that in some states (unfortunately not Washington) there is legislation in place that requires insurance to pay for WLS!!!! i think it's something we should think about starting up here!!!!!

This is exactly the problem I am having--my employer has group health or alliant plus but wich do cover surgery but my employer did not select it as a covered benefit. My question is if the employer chose not to cover WLS or any other treatment for obesity is there still grounds for getting it covered? I guess what I am saying is does the employer who choses what to cover or not cover have final say or is there a chance that it could still be covered because it is covered by "group healt/alliant." Sorry, if this is a little confusing.

HI, I used to work in HR/Benefits. If the employer chose to exclude it, they did it because they are getting lower premiums than if they had included it. The company I worked for said they couldn't see making all of the employees pay higher premiums for something only a few employees would benefit from. But they always include drug/alcohol treatment. Makes no sense to me. Never hurts to appeal a decision, but my experience is, if it is an exclusion on the employers end, it won't be covered.