was covered and now not covered?

I am new to this site and could use some help/advice.  I started the RNY process in October of 2009.  I initially contacted my insurance - BCBS Florida and found that I was 100% covered as long as I had six months of documented weight structure.  Well I have my sixth appointment in two weeks and just found out last week that when my employer renewed our policy on the first of the year they excluded any form of wls. Is there anything I can do or am I wasting my time?  I have reached out to my corporate HR person to explain and see if anything could be done but I have not heard back yet.

Any thoughts or advice you can give would be so helpful.  I have been reading posts on here for the past few weeks in preparation for my surgery and everyone on here is so helpful!

=) thank you!

Unless your employer opts to start paying that premium again there is nothing you can do.  Keep in mind, even if they opt to start paying the extra premium again for WLS it is possible they won't be able to make changes until their next contract year.

My husband's employer did the same thing with BCBSGA (we think). We can't get a straight answer out of anyone, but it does sound like that's what happened to you. Ugh.

The important thing here is the time-line. Does BCBSFL have a copy of a surgical request on file? Or any other documentation pertaining to your RNY request? If so, and if it was before your employer pulled this stunt, you MAY have some recourse. If the date on your request was before your employer dropped the coverage, they may be required to honor THAT date, instead of the date of the new policy.

If you really wanted to fight for it, you may even be able to take your employer up as discriminatory on their policy, because of the exclusion. Or petition them to change the policy, and just sit tight for the rest of the year.

I submitted a request to BCBS in Sept to find out if it was covered and received a written reply advising that it was covered but I was required to have 6 months of structured weight loss from a physican.  I started the process in November so I was already in the process when benefits were changed.  An official surgery request was never submitted because the 6 months was not up.  I have contacted my corporate benefits person with my employer and she is looking into it for me.  I'm not holding out too much hope that they will cover it and have even considered marrying my bf so he can add me to his Health Partners plan which covers it.

Scratch that... don't know why it's giving me problems with editing.

 

"BCBS of Florida announced that as of January 1 of this year, it will not provide coverage of surgical procedures for the treatment of weight loss due to "significant questions…regarding quality of care, safety, efficacy and long-term consequences" and in doing so noted that "there is not enough peer-reviewed information in American medical literature to clearly demonstrate the [weight loss] surgery is safe or effective."

 

http://www.ahip.org/content/default.aspx?docid=10771

 

So it looks like BCBSFL may be who you need to go to, bypassing your employer on this one.