Insurance in PA for VSL

I ran into an issue today with my Highmark Flex Blue PPO 1000 insurance. The first rep I spoke to in Feb, said that I would have to cover 20% of the sleeve surgery, but today the rep said I wasn't covered at all for anything and there were no notes about the previous rep I spoke to.

Because of my income I can get on Medicaid in Pennsylvania. I have been paying for insurance out of pocket, because I like my family doctor and I didn't want to have to go to a clinic. However, the surgeon's office said that it will be covered 80% and there maybe other things like the hospital that won't be covered.

Has anyone in PA used medicaid for a sleeve?

Does anyone think that I should spend more to get a new policy from Highmark which does cover surgery?

Any other suggestions/help?

Thank you!

I don't live in PA but I have a awesome HIghmark Blue Shield policy through my husbands work. It paid 100 percent! But each policy is different and most are according to the employer that picks them for you or if you are picking your own you have to see what it covers and what it don't. I just know the plan we have is hardly ever heard of anymore. When I was on my employers provided insurance it was thru United Health Care and they have many plans. My employer had a rider put on any insurance they offered us that WLS was not covered.

Check out any of them before you decided to change or increase one, you got to know what they are going to cover ahead of time.

As a customer service rep, sometimes we don't know the answer and just sound convincing to make the customer happy and to get off the call.  Sounds like that is what is happening with your calls.

Get online and do your own research on what is covered by your policy.

You can also have medicaid as a secondary insurance I would think. Go talk to a case worker and find out. Good luck.

Thank you all. I looked at a hard copy of the policy last night. Bariatric surgery is in the exclusions, however I was under the initial impression that the way the procedure would be coded by surgeon could over ride that. 

As far as a new plan from Highmark, I pay for my plan indepently. And they certainly don't make it easy to see other plans online, let alone check if they have any that cover a sleeve. I'm not sure if I can call and ask a customer service rep? Would that be a red flag?

I'll have to call about Medicaid too. However the Marketplace said it will take up to 30 days to even hear back from Medicaid once you do the initial contact. 

Coding something to get it paid for although it is clearly on an exclusion list is fraud. I don't imagine the surgeon will be willing to do that, and if he is, what other corners is he willing to cut?

^^EXACTLY what she said!  Changing codes simply to get stuff covered by insurance is punishable by fines and jail.  Any doctor willing to do that is not one that I want to go to.  

can you say insurance fraud?