IT CAN BE DONE !!!!!!

Hi all, I just wanted to give a little hope regarding something that I thought was not doable.  I have indeed been APPROVED for WLS with a policy that excludes any treatment for obesity.  Long story short I work for  a "self insured" company.  I won't bore you with the details here.  I am updating my blog. It can be done.  I have done it.  In three weeks, I will have a date. Don't give up!!! Alice

Hi! does self insured mean the company pays for the inc? My husbands company  has b/c b/s anthem blue access, my husband pays out weekly for his share on ours, and i was told by the INC  that they dont cover anything weight related or any WLS. Do you think i would have a chance at all? any info you could provide me with maybe it would help me Thanks, And Congrats on your up coming surgery iam happy for you.

Self insured (to my understanding) means that it's a company that acutally pays it's own health care costs.  This usually applies to larger companies.  So, I pay my premium to my company, they pay a premium to the insurance company but that premium is more of a "handling fee" for all the paperwork and contracts and such.  These self insured companies are given a "menu" of sorts to pick what will be included in their plan.  The cost for handling goes up for each thing added.  Many companies do not add the weight loss stuff becasue it makes it more expensive. So, I went straight to my benefits department before my first consult with the surgeon.  I spoke with my PCP and she agreed that it was medically neccessary.  I called my benefits people and told them that I had a letter of medical neccessity and they said they would have our insurance review my case.  If our insurance said it was a neccessity, it would go before a medical review board at my company.  I did write a letter to the review board and sent a copy of the letter my PCP wrote for me.  They "voted" yesterday and have decided to foot the bill. I know this doesn't happen every day.  I know I am truly blessed because an exclusion, by nature, is an exclusion.  I am fortunate enough to work for a company that had another avenue for me to pursue.   Try your husbands benefits department and see if there may be hope there.  At least that's where you could start. Good luck!

Hi! yeah thats the way my husbands inc is he pays then they pay, problem is i called inc and they said even if it were a medical neccessity they dont cover it and i even have a dr letter to have it, 2 of them from 2 different drs. Well thanks for the info, and iam really happy for you , i bet you are so excited. My daughter had WLS this past Nov and is doing wonderful has lost 72 pounds so far and fells great. Best Wishes!