My insurance is Bluegrass Family Health and there is an exculsion for weight loss surgery

Hi my name is Angela and my insurance has exclusion for weight loss surgery what can I do to get my surgery paid for? Is it worth doing appeal letter to my insurance.  My insurance is through my husbands employer and they are a small company they have about 50 employees. Is there any help out there for me? I cant afford to self pay we are in the process of buying a new house and just bought a car.  Please fellow weight loss members can you help me give me some advice on what I can do.

try contacting the insurance company and just double checking on protocol.  they might require you to be a certain weight /  bmi

 I have contacted them which they said I could try and appeal letter of medical necessity but more likely to be denied and I should try and talk to the HR department where my husband works. I am not sure how well that will go over my husband stated they probably would not add it to our insurance. I just don't know what else to do. My PCP has stated that I need this surgery that it will prolong my life and ive tried so many different diets and diet pills and I would loose some but the weight would come back and its hard for me to exercise with my limited mobility.  Which my weight gain was the result of a gallbladder surgery gone wrong and Ive never been able to loose the weight and it is to late to do anything regarding what the surgeon done he was fired but the damage was done. I have kids that I want to see get married and have grandchildren but I don't know where else to turn to and whom to ask for help.

When there is an exclusion, it means the policy that was purchased specifically does not include  WLS.  Just like my rental insurance does not cover flooding.  If I wanted coverage for flooding, I would have to pay more and buy a policy that included it.

unfortunately,an exclusion on the policy means that your husbands employer did not buy the coverage for weight loss surgery ,from the insurance company. The insurance company is not going to pay for something that the employer has not bought. That would be money out of the insurance companies pocket and they are totally not going to do that. 

No appeals or letters of medical necessity are going to convince the insurance company to cover it,sorry. 

Your only recourse is self pay,or getting a part time job at Starbucks or Lowes,who both cover Wls even for part time employees. 

Hate to be the bearer of bad news, I know how. You feel,our insurance also has an exclusion. I saved money and self paid inMexico,which was a fraction of. The cost inthe states. Good luck

Thank  you so much for the advise so Lowes and Starbucks will cover there employees for weight loss surgery do you have to work there for a certain period of time? That is great that they do this for their employees. If you don't mind for me asking where in Mexico did you have your surgery and how much was the cost? I have checked out the website A Lighter Me and I know they are in Mexico and I think they advertised the Gastric Sleeve for $4,500 or so.

I believe you need to work at Starbucks for 6 months.  I recall a gal who did just that to have wls.

I would like to know if you don't mind me asking where in Mexico did you go for your WLS?

There's no point appealing it because you bought an insurance policy that doesn't include WLS.  Policies that include WLS usually cost more.  Since you didn't pay for a policy that includes WLS, they won't pay for it.  Just like I had to pay a lot out of pocket last year for some very necessary dental work, because I did not buy dental insurance.  There was no point appealing, because I didn't buy insurance that covers dental work.

What you can do is ask your husband's employer to offer an insurance policy that does cover WLS.  If they agree, then you can purchase that policy, which will probably cost more.

Buying a health care policy on your own that includes wls might be the way you have to go, otherwise you'll just have to pay out of pocket.  I did hear of something called care credit, I think it's a kind of credit card for medical procedures so that you don't have to pay all at once, but over time, but I don't know much about it. Try using the search function and put in words like financing or care credit, you might get more info on alternative ways to pay for surgery.