Employer Override of Exclusion?

Does anyone know anything about this or any resources to point me toward?

Callie, I think you would just have to contact your employee benefits people for your company and be prepared to state a compelling case for why they should try to get this surgery done for you. Have a lot of information about why the surgery would make you a better employee and a healthier person who will cost them far less in the long run if they can help you to overcome present or future health problems. Check around on this site, because there are a lot of links to studies about weight loss surgery and information and you can print them off. Also provide a personal health history, a family health history and any other information that you think will help. I don't know how sympathetic your company would be, but it's worth a try!

JH, Thanks for your advice. I ended up talking to both my HR representative and the CEO of the company today. They are very sympathetic and very supportive. BUT, they're insurance isn't self funding so they can't override. UGH! I'm running out of options here! I've been told that there's no way getting them to reverse the denial. It Reads: No benefits will be provided for any of the following conditions, treatments, services, supplies, or accommodations, or for any direct complications or consequences thereof. GASTRIC PROCEDURES Services and supplies for or in connection with gastric or intestinal bypass, gastric stapling, or other similar surgical procedure, or for or in connection with reversal or revision of such procedures. What do I do?!?!?

The employer can only overide the exclusion if it is self funded. If it's an actual "insurance policy" than the decision is totally determined by the insurance company. In most cases, employer plans are self funded. Read your Summary Plan Description booklet carefully under Appeals, and look at the Fiduciary information.