Hit a roadblock

All systems were go for me to proceed with preparations to have Gastric Bypass and then we hit a MAJOR roadblock... Bariatric surgery is an "exclusion" on my insurance... I've made a few calls, but does anyone else know if there is ANY recourse at all, besides private pay?  Congratulations to all who are finding success with their surgery! Thank you

You can try to appeal.

However, if it is excluded, it means that your company does not pay for the coverage.

Now, some companies keep money in reserve to pay for excluded procedures if they are deemed medically necessary .... So it would not be paid by I surname, but directly by your employer.

You can try to speak with your HR department about that.

My company excludes WLS and I was a self pay, but 2 co-workers were paid by the company that same year, they had co-morbidities that I did not have.

Thank you... I'm devastated by the discovery of the exclusion and hopefully will hear back from the surgeons office tomorrow about any possible ways to proceed or if self pay is my only option, which financially, is not an option for me. :(

I had the same thing and opted out of my company insurance and purchased my own personal insurance that covered the surgery.  Much cheaper than self pay.

Thank you... I'm devastated by the discovery of the exclusion and hopefully will hear back from the surgeons office tomorrow about any possible ways to proceed or if self pay is my only option, which financially, is not an option for me. :(

Exclusions to wls is something that an employer can select to save on premiums, so because the 'customer' ordered the exclusion, the insurance company won't bend.

You can try your HR department to see if they have the option to make acceptions or make changes for the next open enrollment cycle.

Thank you... I'm devastated by the discovery of the exclusion and hopefully will hear back from the surgeons office tomorrow about any possible ways to proceed or if self pay is my only option, which financially, is not an option for me. :(

I work for a small employer who pays our insurance, unfortunately I am subjected to what ever crappy plan they choose.  Our plans have always had the bariatric exclusion.  It is unlikely that they will pay extra to include it into our insurance. So I am doing self pay.  The above posters have some good ideas, but as I understand if its an exclusion... it will not be covered no matter what you do. I shopped around and I am choosing to have surgery in a different state because the cost is lower. Alot of people choose to go to Mexico.  Keep the cost in perspective, you probably wouldn't hesitate to buy a car for the same price.  Good luck to you.

Thank you... I'm devastated by the discovery of the exclusion and hopefully will hear back from the surgeons office tomorrow about any possible ways to proceed or if self pay is my only option, which financially, is not an option for me. :(

My insurance had an exclusion too and I had to go self pay. It took me about a year to save up for half of it and I took about a loan for the other half. It stinks, but it was worth it.  Maybe you can extend your timeline and find a way to make it work. Good luck!