BCBS of Florida for 'fully insured group' - categorically denied

I have BCBS of Florida, and was told that I wasn't covered because my employer had an exclusion, when I went to Dr. Jawad's office.  When I asked, I was told by HR at my company the following:

"Because we were getting conflicting messages about whether or not BCBS offers such coverage, we asked our account representative to do some more research and send us documentation for our file.  As a result we recently received confirmation from  BCBS's product line manager that bariatric/morbid obesity surgery coverage is not available to us at all - not even to purchase it as a rider to our group coverage contract.

 

The reason for the conflicting messages lies in the type of "group" we are.  BCBS allows self-insured groups to purchase a rider for such services as a non-standard benefit (which means at a huge cost to the self-insured group).  However, they do not even offer or allow that as an option to fully insured groups, which is what XXXX is considered."

So, BCBS is the one completely denying my company even the OPTION of purchasing the rider for bariatric surgery.  Yet, the BCBS site says it is covered if it is medically necessary.  Is it worth it to fight, say send in a letter of medical necessity?  Or am I SOL?

Contact  www.obesitylaw.com

That's the exact same thing that is happening to me.  I have a fully insured policy through BCBSF.  I just recently submitted my 2nd Preservice Coverage Review, this time, with a letter of 'Medical Necessity' and I'm waiting to hear the response from that.  I'll let you know how it turns out.  Hopefully "Medical Necessity" is the secret password?

I sure hope so!  My doctor is prepping one as well, which I will send in to the insurance company.  If not, I'll have to start calling the lawyers.

Well, I never did get approval at my old job, but I have a new job, with new insurance.  And guess what?  I already know they cover the surgery, yay!!!  One of my co-workers is getting the surgery next month, and his wife had it done last year.  I have 6 months of doctor diet to do, and then I'm golden.  WoOOH!OOO!O!OO!!