what company do you work for that covered your surgery
I work in HR and second what Tom said, especially if it's a self-funded plan. The company decides what they will and will not pay for, unfortunately.
Perhaps a lawyer may be able to help, but even if you paid out of pocket, they may not cover any expenses related to or caused by WLS either. Best bet is when it's your open enrollment plan, see what plans cover WLS. Because you have to keep in that for mind follow up visits, blood work and worst case scenario of complications; the self pay plan may not cover anything related to it, and those could be costly.
I orginally was banded and due to complications had to have it out and revised to RNY, and I also had to have adhesions removed from all the surgeries and my gall bladder removed a month ago, as a result of the WLS. Had I been a self pay, I would have had to pay for all of those surgeries myself. I am blessed to have a husband who works for the state of NJ and didn't pay a cent for anything, just random co-pays.
I hope that helps, and I am not trying to sound negative, but when a plan is self funded as opposed to a plan that pays premiums and cover more items, it really changes how things work, sadly.
Maybe Tom has better info to share, I am just sharing what I have seen working in benefits for so long, and that my insurance was once a self-funded plan and was very limited on what would be covered; i.e. - I needed to be on the pill for medical reasons and no matter what I did, the self funded plan would not cover it. Didn't matter why I needed it, they just wouldn't cover it. I had to pay for it or not take it.
Why don't you try posting this on the board of the surgery that you are looking to have, maybe someone there can shed more light on the situation.
One more thing - why don't you ask the HR department for a copy of the Summary Plan Description (SPD). This is a booklet that the HR dept can provide to you that is the plan document, which specifically outlines what's covered and what's not. It may even be available online through your plan's administrator.
Maybe there is something in the language there that can help you or your doctor's office get this covered. Often times the way things are worded can be interpreted in a variety of ways.
Best of luck, and I wish that I had better news to share. Let me know if I can answer any more questions for you.
Perhaps a lawyer may be able to help, but even if you paid out of pocket, they may not cover any expenses related to or caused by WLS either. Best bet is when it's your open enrollment plan, see what plans cover WLS. Because you have to keep in that for mind follow up visits, blood work and worst case scenario of complications; the self pay plan may not cover anything related to it, and those could be costly.
I orginally was banded and due to complications had to have it out and revised to RNY, and I also had to have adhesions removed from all the surgeries and my gall bladder removed a month ago, as a result of the WLS. Had I been a self pay, I would have had to pay for all of those surgeries myself. I am blessed to have a husband who works for the state of NJ and didn't pay a cent for anything, just random co-pays.
I hope that helps, and I am not trying to sound negative, but when a plan is self funded as opposed to a plan that pays premiums and cover more items, it really changes how things work, sadly.
Maybe Tom has better info to share, I am just sharing what I have seen working in benefits for so long, and that my insurance was once a self-funded plan and was very limited on what would be covered; i.e. - I needed to be on the pill for medical reasons and no matter what I did, the self funded plan would not cover it. Didn't matter why I needed it, they just wouldn't cover it. I had to pay for it or not take it.
Why don't you try posting this on the board of the surgery that you are looking to have, maybe someone there can shed more light on the situation.
One more thing - why don't you ask the HR department for a copy of the Summary Plan Description (SPD). This is a booklet that the HR dept can provide to you that is the plan document, which specifically outlines what's covered and what's not. It may even be available online through your plan's administrator.
Maybe there is something in the language there that can help you or your doctor's office get this covered. Often times the way things are worded can be interpreted in a variety of ways.
Best of luck, and I wish that I had better news to share. Let me know if I can answer any more questions for you.
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