Written Exclusion Policy

I have Regence BC/BS and there is a written exclusion on all obesity surgeries and weight loss tools. Is it worth it to submit and appeal? I'm not looking at having the RNY, which seems to be the standard they approve. Do you think I have a shot or should I just resign myself to paying out-of-pocket? I'm concerned if there are post op complications that I will have to pay for that too if I can't get it covered.

If it is written in your policy as an exclusion then appealing is a waste of time.  If it were not an exclusion and you were denied then by all means appeal.  Since your employer excludes the surgery the insurance company cannot overturn the decision.  The insurance company administers the policy for your insurance company.  Hope this helps.

You have the right to appeal most decisions by your health insurance companies, so please keep that in mind.  I don't want you to think that your cause is a lost one. If you find that you have to go the self-pay route, you might want to look into setting up a flexible spending account to assist you in covering the costs of the surgery or any follow up that you may have. Flexible spending accounts are tax-protected health care accounts that allow you to set aside a preset amount of money for medical expenses (typically excluded expenses).  The money to fund the account is deducted from your payroll on a consistent basis. Important considerations regarding flexible spending accounts is that you have to use the money you have designated before the year is up (unless there is a grace period), or you will lose the money (employee risk).  On a postive note, in most cases, you can use all the money in the account  before you have actually accrued it (employer risk). It's something to think about at least.  I wish you well in your weight-loss journey.