My ?Insurance co. Doesn't cover bariatric surgery! Any suggestions?

If it is specifically excluded in your policy, there is nothing you can do to have them pay for it. Medical need would not matter if it is excluded.

In rare cases this can be appealed according to even my own insurance company. It would have to be fought and appealed with your surgeon and several doctors backing you up but it has been done. I would say though that if it isn't highly recommended by your doctors that this fight wouldn't be worth the hassle.

You can appeal it 100 percent of the time if you want to. But if the policy says "no bariatric surgery of any type, and no treatment for obesity," they will lose 100% of the time.

If the policy does not say those things, and you are rejected, you should absolutely appeal. That's when doctors get involved, arguing medical necessity, and you'd have a good chance of winning.

If you buy cheap car insurance that will pay for bodily injury only, and not collision, they will never pay to have your car fixed if you hit something. If someone bought less expensive health insurance that didn't include bariatric surgery, they simply will not pay for it.

I 100% realize what you are saying, this has always been my thought on the matter until I started trying to get approved for this surgery. However, I'm just saying that my own insurance company told me that if appealed correctly that sometimes things not in your policy could be covered. Then again, my insurance company has told me wrong before. I really feel like it usually boils down to who you talk to as sad as that is. Once after my surgery was denied the first time, my insurance told me that since it was denied they'd no longer cover any obesity related issues. I got a bill telling me that they weren't responsible for it. I had to call probably 10 different times and several of them argued with me that I was wrong but that 10th person simply took care of the bill with no further hassle. I have really good insurance but it still really matters who answers your call. Like I said, I may have been told wrong. The best thing to do is talk to your insurance company several times. You should never be satisfied with the answers you get the first time. I had one person tell me I wasn't covered at all when in fact I was!!

Never heard of this ever happening ever and I have been around more than a decade.  But great if it does!  Things change.  I think though companies/employees pay a certain amount in premiums for specific insurance.

Best,

L

My policy's wording; however I have received approval for the RNY:  

Some of the listed exclusions may be Medically Necessary, but still are not covered under this plan, while others may be examples of services which are not Medically Necessary or not medical in nature, as determined by the Health Plan and/or PBM.

1. Surgical Services b. Any surgical treatment or hospitalization for the treatment of obesity, including morbid obesity or as treatment for the Comorbidities of obesity, for example, gastroesophageal reflux disease. This includes, but is not limited to, stomach-limiting and bypass procedures.

1. ==   Above is my wording for Exclusion ....  however, I have a unique situation regarding my health issue that came on abruptly Jan 2015. With many Urgent care visits in January with no real identification of what was occurring outside of running its course for bronchitis.
3. My research of my symptoms etc ultimately self diagnosing myself. Saw an ENT for consult and various tests including the 24 hr-PH esophageal manometry even being on Omeprazole 40 mgs 2x/day for 4 weeks prior to this test. Findings showed I was still having LPR (non-acid)Reflux above and beyond what I should have being on this medication. PPI meds will never resolve LPR- only reduce symptoms.  
5. Now when I say Reflux - its NOT GERD that I experience but-- Silent GERD or LPR (laryngophargeal reflux). Its exactly what I thought perhaps I had.  Typically, this would be resolved with the following surgery >>  Nissan Fundoplication. However, with my surgeon consult I soon learned that this surgery would fail for me after 2-3 years due to my excess weight.  Surgeon asked if I ever considered Weight Loss Surgery - specifically RNY?  This would completely resolve  my LPR, also I have Sleep Apnea and provide me with the tool  to lose weight. I'm 5 foot 2 at 216 pounds.  
7. My surgeon indicated my insurance group typically, is amendable to approving this surgery due to my LPR and he would do what ever it takes to have this approved with appeals etc. (Afterall, surgery would have been Nissan Fundoplication - but with a failure rate in obesity patients - it would be more cost effective for insurance carrier to approve RNY vs Nissan Fundoplication needing to be done twice perhaps)  
9. My insurer approved the RNY after a Peer to Peer meeting with my Surgeon. But was put on hold/delayed due to me getting a new job. Fortunately, we went on my husband's insurance which has many policies to chose from - one being this same carrier!  With job switch - and needing to delay a bit due to new job with probation period.
11. We are now back in the process to have this RNY authorized again for me.  Another Peer to Peer occurred last week for approval of the Education classes, now approved and I'm enrolled in the December classes. Once completed- submission for the Surgery will take place and approved allowing me to have surgery by February.  
13. Due to this LPR medical condition and the seriousness of it; I do not need to do a 6 month weight loss program. In addition, I am very happy I discovered this Obesity Help website and the wealth of knowledge found with all posters.  I know as I start my journey - I also hope to share=)  Classes begin Dec 5, 12 and 19!  
15. === So depending on your health issues- and comorbidities and your surgeon dedication and follow-thru to appeal any and all denials by an insurance carrier - a surgery for RNY or Sleeve may be Approved due to Medical Necessity.  Keep working with your surgeon and primary care physician.

Sorry for the numbers -- was trying to put some ... white space .... in between!!