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Hi. I'm new to the site. I am hoping to have WLS, leaning towards the sleeve if I can. If not, I will do bypass.
I called my insurance (highmark BCBS) and asked if they cover WLS and what the requirements are. I was told that it's not approved. However, if I can get the proper diagnosis and procedure code, they MAY cover it.
So my question is, what do I need to get from my Dr to convince them I need this surgery? I have no co-morbities but do have quite a few things related to my weight and my BMI is 51.
Any help is greatly appreciated.
I was in the same boat. My group plan was with UHC and WLS was excluded and the kept telling me to appeal. I did that and finally found out that my employer did not purchase the rider. My doctor and I sent my employer letters explaining the need for this. They looked into it and later refused because the cost was to high. Doing my research I found out that the WLS ridder would have cost $1.04 per month to each employee. That's it $1.04. I got with a good private health insurance agent and she helped me find a private policy that covered WLS. I left my group went to a private plan. My monthly premium is $30 more a month than my group. My WLS was approved in less than 24 hours.
You still have options. Don't give up.
Has anyone been able to get approval for surgery through Aetna International for gastric bypass ?
Hi,
Can anyone help me please? I wanted to undergo lap band surgery, I weight 191 lbs and have a severe sleep apnea but when I sign up for online request more information about lap band in a one hospital in Wisconsin..I received a call a woman from that hospital explaining things to me and told me that I'm not qualified cause my insurance only covered a bmi above 40...I don't really know what to do, I'm very frustrated can someone please help me? It sound to me that she don't coordinate much more to my insurance please help?
Thanks,
fhel
My employer would not add the ridder to our group plan ($1.04 per month cost to each employee on the plan)
i moved to a private Presbyterian plan on January 1. On Friday January 10 I sent insurance card to barriatric office the following Monday I had my approval before noon.
a rider is a type of add on policy to your main policy. Most individual policies don't cover Wls because the person would might just. Cancel the policy after the insurance paid for the surgery and they wouldn't get their money up from in premiums.
The very few policies I have heard of that might cover i,the monthly payments are very expensive.
gl
I don't know what a rider is. I will be buying individual insurance. I'm not working.
Thank you so much for your response, I guess I won't sit around and weight for the response lol. When I called them they said there were some adjustments made this year to the plan and I needed to send in the appeal. We'll see what happens but I won't bank on it.
it is not just about the insurance company. All insurance companies cover WLS...IF the employer buys the rider that covers it's when looking to change policies,you need to make sure whether. Your employer has bought the rider first of all,and then find out. What the requirements will be.
GL
sorry to say,if WLS is EXCL uDED in your plan,that means your employer,( the insurance company) did not buy the rider that covers it for their employees. If they didn't buy it for you,then that means the premium you pay for. Your insurance isn't covering. WLS.
No amount of appeals/letters is going to change the fact that the rider is not being paid for. If someone isn't paying for the rider,the insurance company is. Not going to cover it.
sorry and good luck
about your. Only option will be self pay
Hockeymom87 · 0 replies · 617 views
