Understanding Insurance Jargon... HELP PLEASE

Ok, I give up... I concede... I am not as smart as my mother swears I am, lol! I got a letter in the mail today (actually, my husband did, but I am nosey and I opened it!!!) and I am having a hard time understanding it. When ya'll have sent as many letters as I have and made as many phone calls as we ALL have, you don't want to jump to conclusions about what might be hidden in between the lines. Please, I am posting what the letter says in its entirety. If anyone could please help me understand what it means, please, please, PLEASE... I am begging you... give me your interpretation.  What I am wanting it to say is that BCBSofGa DOES cover Gastric Bypass, but my Employer choses not to cover it. But I can't tell if it says what I want it to or if it still says that BCBSofGa as a whole does not cover it. ok, ok... I'll just let ya'll read it... Dear Mr. Cope, We have recieved your inquiry about the services listed above. Our research indicates the following: GASTRIC BYPASS IS NON-COVERED BY YOUR EMPLOYER. BCBSGA HAS NOT DETERMINED THIS BENEFIT EXCLUSION. PLEASE CONTACT YOUR EMPLOYER FOR FURTHER EXPLANATION. If you have questions, please call or log on to our website or contact customer care at 1800-441-CARE from 7 to 9 M-F.  Sincerely, Blue Cross Blue Shield of Georgia

I'm only as smart as my dog thinks I am, so take my response as you will!! I'm reading that to mean that the employer has chosen to exclude gastric bypass from its insurance plan - that BCBSGA did not make the decision.  Furthermore, they are advising you to contact the employer for an additional explanation of why the procedure is not covered. It would be worth it to find out from the employer for sure.  Ask them why it isn't covered and if they plan to change their policy coverage in the future.   Good luck to you!

I concure with the previous post... i know BCBS of GA covers weight loss surgery - but it is in a bundle that your employer has to chose as an option for its employees.

I agree with the other two posters.  But I feel there could be good news between the lines.  They could be telling you that when you talk to the employer find out if you can pay for a rider (additional polocy, I think) or if you can get them to change their coverage benefits.  Don't give up hope.

Michelle, As one who has helped over turn denials and appeals for getting wls covered, I too, agree with the other posters BUT, I have a different spin on it. Since BCBS of GA does cover it you can certainly go directly to your hubby's employer and talk to the Human Resource's manager and they can decide based on the info that you give them from your docs and approve you. It does not have to necessarily be in their plan, with self insured companies they can do whatever they want. Let me know if I can help you any further. Crece

Wow! Thank you all sooooooo much! I was hoping that I was reading it correctly, but I didn't know if I was just WANTING to read it that way... if that makes sense?!?! LOL Everyone here knows the struggles that we all face just trying to save our own lives. It seems like the more we try to do to be healthy, the things get in our way. Like I will NEVER understand why health and organic food is so expensive, like they don't REALLY want us to eat it. But I am determined to do this for myself and my family, even if I have to pay out of pocket 100% for it. It just makes it easier to have ya'll to talk to while going through the rough spots. Thank you all again! ~Michelle

I agree, this is not a covered procedure through the company.  However, the company that your husband works for chose to exclude the coverage.  It is worth a try to call them and advise them of your situation.  But, as an insurance professional (by trade) per the policy, if it says exclusion 9 x's out of 10 it will not be covered.  Now for that one part, the insurance comp. BCBS can opt to have the employer pay the additional premium: back premium and have it covered.  But this is rare.  And, this is only if they ins comp is willing to be on Good Faith with the employer. Good Luck!  Nicole