What does "procedure is corporately not covered" mean?

I just got a letter in mail today from BC/BS saying no benefits are available to me because, "procedure is corporately not covered". What does this mean? Does this mean the place my husbend works (thats where we get our insur. from) doesn't have this on there policy. If so, what can I do? He works at a small privatly owned company with only 15 employee's, will that make it harder for me? Whatcha think? Colleen

Possibility - company is self-insured using BC/BS network and administration. Self-insured companies write their own policy as to what they will and will not cover. WLS may be an exclusion that your husband's employer has written. I'm not sure but that might be a possiblity. My husband works for a self-insured HOSPITAL that excludes the treatment of obesity. Good luck on your fight!

I thought I was apply for "open RNY" the letter said "gastric restrictive procedure code 43847", whatever that means. Colleen

First of all, 43837 is the procedure code for the DS, not the RNY. Lucky you if your surgeon is offering the DS! If you haven't considered it, I would suggest you do! Second, a friend of mine got EXACTLY the same denial in response to his first request for the DS procedure with BC of IL. After preparing his appeal with the help of Walter Lindstrom, including letters from his various doctors supporting his need for the DS, he was denied again -- but for much different reasons and only until he submitted additional letters from his heart and kidney doctors clearing him for surgery. He was approved by BC on Monday. Good luck! Diana DS Robert Rabkin 8/5/03 285/225/160?

Hi Colleen! My husband's insurance is Wellmark BC/BS and it still covers WLS with 3 years of physician supervised weight loss attempts, but his employer has a written exclusion to ALL treatments of obesity, whether surgery or prescription drugs, or weight loss programs. His employee benefits handbook is worded the exact same way. Thank goodness we also have additional insurance until 11/04 that does cover WLS. I wish you luck, Sweetie! Sherry

Hi Sherry, what kind of additional insurance did you have? is it a type you can buy if you think that your insurance may not cover the procedure? Kim