What my ins. says... see anything that should concern me?

This is kind of long and technical. Thanks in advance for any help. My hubby works for a company that offers 2 different insurance options and open enrollment starts Nov 1st. The current ins. completely excludes any type of weight loss surgery for any reason. The other ins. says this: Weight Loss Surgical Procedures. Coverage is provided for * weight loss surgical procedures, including gastric bypass surgery, * surgical procedures preformed contemporaneously with weight loss surgical procedures, and * treatment of complications resulting from the weight loss surgical procedure or from a surgical procedure performed contemporaneously with a weight loss surgical procedure. Coverage provided for this benefit is conditioned upon *Blue Cross Blue Shield giving approval prior to the surgery, surgical procedure, or treatment, AND * Coverage policy supports the need for surgery, surgical procedure, or treatment. If a covered person has had a weight loss surgical procedure or a surgical procedure performed contemporaneously with a weight loss surgical procedure prior to coverage under the Benefit Certificate, such weight loss surgical procedure or contemporaneous surgical procedure must meet the standards of coverage policy in order for this benefit to apply to complications resulting from such surgical procedure. Does this look like everything I need to determine that it'll be covered. It doesn't say anything about the 6 months monitored weight loss, but I am going on the 4th one anyway and will be done with that the first week of January. Jenifer

which BCBS is it?  there are many different ones. answer that, and I or someone else will be better able to help you. edit to add.... I just dug around, and while there MIGHT be more, I could only find one BCBS in Florida.... so if you are BCBS-FL, then you can see everything you need to right here: http://mcgs.bcbsfl.com/index.cfm?fuseaction=main.main&stage=pub&format=cfm&doc=Surgery for Clinically Severe Obesity

Thanks for your response. It is BCBS of Arkansas. Alltel is his employer. My guess is that this is just the summary and that there has to be more specific language about the requirements for the surgery. I did find this  http://www.arkbluecross.com/members/report.aspx?policyNumber =1998118 but I just am not sure that this is standard for all of their policies. Doesn't it depend on the coverage & requirements the employer chooses, so it would be different for each employer??? I don't know, but I do know that I am very confused and I just want to be sure that I am not switching insurances for nothing. Jenifer

No... Alltel decides whether it's an exclusion or not. from the blue in your first post above, that tells me that they do NOT have a written exclusion (which is great for you). now that we know it's covered, we need to know the BCBS requirements to be approved for the surgery.  THAT info is within that link you just posted above.   The employer wouldn't make any more or different requirements.... they leave that up to the insurance company.  The employer only decides if they want to save a few bucks by having a written exclusion. hope this has helped.  good luck.

Hi Sean & Paul. Thank you both for your responses. Paul- in response to the part about employer initiated exclusions- The actual wording that I posted came off of the MY BENEFITS link on the Alltel website as a benefit summary so we are good to go I think. I guess that I have read sooo many stories about denials because of language in the policy that I am a little paranoid about getting to that point and being let down so I that is why I brought the information I had here for help. Your interpretation of the language pretty much was my interpretation so if we both got the same thing out of it, we must be understand it. I have such an issue with rejection and sometimes I feel like if it can wrong it will go wrong for me, so I tend to be very careful about getting my hopes up. I am sure you guys understand. Jenifer