Vicki B. (or anyone who can) HELP PLEASE!!!!

OK, this is going to be pretty long so please forgive me but I need to give a little background info.
I have BCBS of IL through my husbands employer, it is a self funded plan.  There is a written exclusion for gastric bypass which reads: " Services and supplies rendered or provided for gastric bypass surgery."  The surgeons office sent in a pre approval request specifically for RNY  and of course I got denied.  I hired an attorney and tried to get the decision overturned to no avail.   So, here is my question:  Do you think it would be worth it to try and get the Sleeve approved since the exclusion is written so specifically to bypass?  And if so how do I go about doing that with out getting the surgeon involved again?  My current surgeon does not do the sleeve and the nearest one who does is about 100 mi from me, and they will not submit it until I drive up there and go through the seminar and have a consultation appointment.  I really don't want to drive up there 2 different times and spend the money for the consultation until I know if I can get approved.  Any info or suggestions will be greatly appreciated! Thanks!!!!

Call BCBS and ask them if the sleeve is an exclusion. If they cannot be clear on the answer then I'd drive faster than hell and get that dr to submit his papers. If they shoot you down I'd higher the attorney again and go after them for it. They stated gastric bypass, not bariatric surgery or the band... I'm try

I am a little confused.

I have BCBSIL, and the surgery is covered as long as it is a medical necessary.

So your saying that BCBSIL has an exclusion on RNY? ! I wished they would of told me that over the phone!!!!!

NOW I AM UPPPPPPPPPPPPSET

If they told you that it is covered you are probably fine. My policy is self funded through my husbands employer, they are the ones who excluded it, not BCBSIL. 

I would definitely go for it.

And if I were in your shoes, I would exploit that loophole for all it's worth.