HELP! Kroger Insurance Exclusions

Help! It's open enrollment time. I called both Anthem HMO and Humana HMO and they both have exclusions on WLS. Anyone successful at getting either of these two insurance companies to pay? I would especially like to hear from any Kroger employees who have had any success with either of these .... or any of the PPO plans we are offered. And if you are not a Kroger employee, I'd like to hear from anyone who has had a policy pay even if there was an exclusion present. Time is crucial since open enrollment ends on Friday. Thanks for any help you can give.

I do not have a good answer for you. Basically if it says Weight loss surgery is excluded they won't pay. BUT that being said. It is the EMPLOYER who decided to have that exclusion put in. Also don't go by a phone call. See the actual words. They make a difference. CSR's are trained to discourage. Just some thoughts.

I know Kroger is a huge company, but try to get a meeting with the benefits administrator. He or she may have the power to make an exception to the exclusion if they feel it's in the company's best interest. If you are a valued employee and can show good reason for having the surgery ( co-morbidities, savings on health care and prescriptions costs for them ) they might give it the OK. Best of luck to you and don't give up. I've been fighting for this for two years and am just now getting there.

Thanks everyone for responding to my post. I have an update. I sent an email to our director of H.R. and told her my predicament. She did confirm that our company excludes this surgery. She mentioned that this is not the first contact she's had with disappointed associates and wanted to, with my permission, forward my letter to the Vice President of Corporate Benefits. She also mentioned that another employee is going to Mexico in March to have the surgery. Darn shame they have to go to a state that doesn't have the same strict regulatory agencies or the experienced surgeons we have. Talk about increasing the risk factor. Anyway, in my response to her I gave her permission to forward my letter and made a point to mention that I was sure the VP would not use my name in any communications with other memebers of our company per HIPAA guidelines. (I was worried that he may share my name with others without my OK.) The letter was very personal and heart felt, but full of medical facts from the CDC and the National Institute of Health. I also mentioned how the State of Ohio cares enough about their citizens to cover this life saving surgery through Medicaid and it was a shame our company didn't hold it's employees in the same regards. And I mentioned that many companies with exclusions will pay for the surgery on a case by case basis. I straight out asked that the exclusion be overruled in my case. It's a long shot, but we'll see what happens. And if that doesn't work... there is always the law firm in New York that will write a letter to your employer on your behalf. It's only a mere $250, but if it works, it's worth it. I was very sad yesterday, but got my fighting spirit this afternoon. Writing that letter empowered me. I'm not going to roll over and accept what they won't give me. I deserve better. I've given this company 14 years of my life. Anyone interested in the attorney's web site, here's the url: http://www.obesitylawyers.com/index.html Thanks again for all of your support. Natalie