HELP! Ideas? Surgery not covered in company plan

I was under the impress that my insurance would cover my lap band surgery. I've completed ALL pre-op tests: psych eval, upper GI, nutritionist visit, and sleep study. Now the surgeon's office let me know that my insurance will not cover.

I looked into it and it's my work's group plan has excluded ALL bariatric surgeries for reimbursement.

I've already went ahead and called back the surgeon's office requesting them to speak with my insurance and get a formal letter sent to either them or me stating why I am denied. From there I will try and appeal.

I'm feeling really sad but I'm determine. What do I need to do to get this covered? Any suggestions? PLEASE HELP!!!

I know exactly how you feel. I went through the same thing with two different insurance companies. I now have insurance that does cover bariatric surgery but it has taken me since 2004 to finally be covered. All I can tell you is to appeal and appeal again if denied on the first appeal. With my experience,  if it is an exclusion in your policy then it probably won't work but it doesn't hurt to try. I do wish you luck and hope that your insurance does come through for you. God Bless!

Let me tell you, I know ALL about this!  However, I went through parts of the process that I knew I could complete and then finalized everything once I got approval from my company.  To be honest, that part was actually fairly easy compared to what I thought it would be.  I contacted the head of our benefits department at corporate at asked them if they had an exception policy and wa-lah, they did.  Basically it included a tenure requirement with the company (5 years which I met) and then they wanted proof of previous diet attempts, information on the post operative care and that was it really.  I put together a pretty comprehensive package for them including previous medical records and a letter from both my PCP and my surgeon and I was approved very quickly.  However, they only cover $5000 of the expenses (after meeting the deductible) so the rest is up to me.  It's been a tough journey because half the time I was treated as "self pay" and then after gaining approval, limited coverage.  I was originally scheduled for surgery next Weds (12/16) but found out on Friday that because it's an elective surgery, the hospital will not set up any kind of payment plan for me so they expect the entire $15K paid in full 5 days prior to surgery.  Since I can't make that kind of money appear out of thin air, I had to cancel the surgery and hope to get it rescheduled once I can work something out.  For now, I am on hold. 

Hope that helps at least a little but please feel free to send me a message if you have any additional questions.

Good luck
Jessica

If WLS is excluded from your plan there is little you can do about it other than to ask your employer to pay the additional premiums they have to pay to buy WLS coverage.  It's pretty expensive and that is why many employers (most) do not pay for it.

If you end up self pay I do NOT suggest the band, the re operations, port flips, kinked tubing, fills, unfills, xrays, etc... it's verrrry expensive.  Sleeves are so much cheaper in the end and better weight loss with fewer long term complications.  Best of all... no maintenance and no aftercare.  Get surgery and you are done for life.