Insurance - Not Covered

Hello,

I'm new to all of this and am encouraged by everyone's testimonies and progress. I started to do some research on my insurance coverage and my carrier seems to be a bit obscure. (First Service Administrations, Inc.)  It's through my husband's work.  They clearly state that they will not cover weight loss surgery.  I am interested in the RNY.

Is this something that I should still pursue with them? I would be interested in hearing what suggestions you may have. 

Thanks!
Alicia

Ps.  I am in Charlotte County but have already been contacted by the Palms of Pasedena out of St. Pete.

Alicia, keep in contact with Kelley at Dr.R's office, she's the guru when dealing with insurances and other ways to pay for all of the weight loss surgeries. Some insurance companies say that WLS is cosmetic and not covered such as an exclusion from employee benefit insurance UNLESS your Primary doctor has stated/documented in your records that IT IS Medically Nessacary.

Since you mentioned that your company is a bit of obscure I am wondering if you have a self funded plan.  If that is the case your employer can opt to cover the surgery.  So the first thing to do is to find out if this is a self funded plan.

Red

My suggestion is to have the company email you the exclusion clause.  Sometimes it may say something to the effect of wls not covered if not metabolically induced, or wls not covered except when in treatment for the following.... so make sure you get a copy... then take this to your surgeons insurance guru and discuss it with them... Sometimes there are ways to work around exclusions depending on how its worded.  Hope this helps, this is how my surgery was approved.