Advocating for coverage

Last year, I was denied coverage through our employee group insurance plan. I appealed but was told our employer excluded weight loss surgery from our plan. I made multiple calls and sent some links and emails to the HR department last year to encourage them NOT to exclude it this year for 2015 coverage. Unfortunately, I saw the new policy which specifically says weight loss surgery and cosmetic surgery is excluded again. 

Its time to to increase the pressure. 

Before I pour my life into this project, I would like to make sure I'm not trying to reinvent the wheel. Does anyone have a presentation or something put together to encourage a company to get coverage. I would like this to not only make its way to the HR department but all the way up. They need to see the cost savings it provides. The HR department doesn't seem to understand the bottom line, but I'm thinking someone higher up would get it and insist on better negotiations from the HR director. 

Thanks for any help in advance. 

Hi

We are sorry to hear all you are going  through and understand the issues with insurance or "lack there of".  Please post this on the Insurance, Cash Pay and Financing  for more responses.

Keep us posted on how you are doing.

Regards,

Kathy

Member Services

To include WLS coverage for a group - it means that the company would have to pay much much higher rates for EVERY employee that is covered through insurance. If the company pays 100% of your insurance- that would mean much more than they are paying now..  And since Obama care was introduced - the insurance price went up significantly. 

If they only pay a proton and employee pay the rest - that would mean that for a one person who wants/needs the WLS - everyone else in the company would have to pay more... 

You can try to find another job, or pay from savings or take a loan. 

you can also get on the insurance exchange and try to find a insurance that would pay for WLS (good luck with that)

Does your job have a union? Health coverage on my job is negotiated between the company & the employee & going to the union might be a better bet than going in alone, at least they would have a better idea as to how many people would want wls to be included in the plan rather than just you alone who wants it.

You might just have to get an insurance policy on your own that includes wls & opt out of whatever policy your job provides, or just pay for the whole thing yourself.

You can try a petition around the company to get employees to support and testify to  be willing to pay higher rates overall  or those employees (and family) who may benefit from wls.  That's probably the only way you can effectively get them to spend more money...but it still won't happen this year.

I have a few resources that I can share with you feel free to email me [email protected] 

Good for you for being proactive you will be helping many I'm sure if you can manage to convince the powers that be to add the benefit in future policies. 

For you, you might consider contacting Lindstrom Obesity Advocacy if there is a loophole or angle in your policy that can be worked Walter will be able to find it (a bariatric patient, attorney, former OAC Obesity Action Coalition Board Member, great guy I highly recommend a call to him) http://wlsappeals.com/

Michelle "Shelly"

Although I understand what you are trying to do, if you are going to try to convince them to cover WLS based on cost savings, the most recent data will blow your argument completely out of the water. 

First of all, the premiums for adding bariatric surgery can be quiet high.  That means that every employee (and/or the employer will pay on behalf of every employee) is going to pay significantly more for coverage that only a very small percentage of people will use.

Secondly, I work part-time for a group of bariatric surgeons and while I was waiting for a late client one day, I was reading some material they left in the office for the Psychologists and the RN to read (journals, insurance memos, and various things related to bariatric surgeries of all kinds).  According to this article from one of the insurance organizations, overall medical expenses (thsie outside of charges for the surgery and that particular hospital stay) generally increase significantly during the first two years following bariatric surgery, and there is little cost savings overall (obviously, however, there will be individual variations****il almost 5 years out.  Moreover, a high percentage of people don't stay under one insurance plan for 5 or more years... so the insurance company that is paying for the surgery, the post-op care for the first year, complications during the first couple of years, and the expenses for continuing medical care for health issues not immediately resolved by losing weight (e.g. heart and circulatory issues) isn't likely to be the one that sees the cost savings after that 5 year period.

Also, if your company is self-insured, they will only see the cost savings if you stay employed there for more than 5 years.  So, IMO, the problem is that they DO see the bottom line!

I think you would be far more successful waging this battle on a different front... perhaps based on less sick time used by people who are not MO or SMO?  Increased productivity? The problem with that approach, however, is that it could actually backfire and result in 1) reinforcing negative views of people who are obese as poorer workers because they are "unhealthy", and 2) the company considering going to a plan where there is a surcharge for people who are significantly overweight (as some companies are now doing, and as many companies have already been doing for quite some time for people who smoke).

Lora