Premera Microsoft Ins?

Hi, I was wondering if anyone can give me more info on this Premera administered Microsoft Ins. Policy and coverage for the WLS.  When I phoned the customer service line today, I got quoted the Weight Loss Management Benefit information, sounded like a script.  She said they would cover 80% in network, with a lifetime Maximum of $6000. with two comorbitities.  From what I had read here at Obseityhelp.com, it was sounding like they would cover 100% if deemed medically necessary.  Any info anyone might offer will be extremely appreciated. Thanks in advance, Deb Watson

I had lap band surgery in 2006 that was covered by Microsoft. Whoever the Microsoft employee is in your family can look up the benefit information online. There's also an internal email alias for lap band patients or people considering the surgery. Essentially it's 100% covered with a covered surgeon/facility. There are two cir****tances. If you have a BMI of 40 or above it's covered. I've never heard of anyone getting denied. If it's 35 and you have two co-morbidities as assessed by your doctor it can be covered. That was my case. Premera initially denied it but both the doctor and I appealed saying that the benefits statement didn't specific exactly which co-morbitities were required and did not allow for Premera to override a physician recommendation. The medical director agreed and my surgery was covered. All fills were subsequently covered too. Hope that helps, Britt

Thank you SOOOO much for replying Britt.  In the interim, my husband, the employee did speak with another Customer Service person, and she sent him the entire policy, and I received my Microsofthealth.com passcodes etc., so I was able to look Morbid Obesity Surgery up on there.  My BMI is way over 40, so technically, I would assume I will be covered.  It is still SOOO reassuring to hear that it was covered completely for you, and others.  I was in the process to get the surgery back in 2002, only to loose my health care coverage and the opportunity to have the surgery.  I was devastated.  My husband had a really hard time finding any permanent jobs, with benefits for close to 4 years!  He was relagated to contract work, which in the IT field pays okay, but leaves you with periods of unemployment which is deadly with 3 kids and a mortgage!  With this, his second time contracting at Microsoft, he was hired permanently.  With all the struggles we've endured, getting this job has felt like such a Godsend!  We keep thinking we might be dreaming.  Anyhoo, I attended the sugery seminar at the center that is listed with the Permera Directory, so I am assuming that they are in the network.  I have my consultation with the surgeon next Tuesday.  There is some comment about "A benefit Advisory being recommending" in the policy information.  From what I can tell that is something that when you are a borderline case, they might sway you to attempt another method first.  I am curious if you dealt with any of that?  Thank you again for responding.  I truly appreciate the info. Sincerely, Deb

Dear Britt, I am sorry to be a pest.  I had one more question that if you would answer, I would be most grateful.  Did the Ins. cover your pre-op liquid diet??  My surgeon requires a four week liquid diet pre-op, and the only Ins Policy info online I can find about liquid diet says that it is excluded(?), but then it says under the Surgery for Morbid Obesity that all services and supplies are covered, so I am confused.  My husband says our budget is terribly tight right now, he is commuting 90 miles daily, both to, AND from Microsoft until we can get ourselves moved, so if the Ins. will cover this also, that will be very helpful in our situation.  If not, and you had to buy it yourself, can you tell me what you used and what the cost was for it? Thanks again Britt for responding.  It is kismit, my cousin is due to deliver her first child in a month and 10 days and they have chosen (Britt) for the babies name!!  No kiddin!  How cool is that?? In most grateful thanks, Deb

Hi Deb, I didn't do a liquid diet beforehand so I don't know about insurance coverage. I did the liquid diet afterward and didn't check to see if it was covered but I'd doubt it. I tried a lot of liquid products and found some really reasonably priced ones that I liked. On bariatriceating.com you can buy different samples and you can also buy the flavorless unjury. I really like Syntrax Nectar - not thick and great flavors including the coffee one. And I recently bought a lot of stuff from http://www.newlifestylediet.com/ which I thought was great - I didn't much care for the shakes by themselves but I loved the sloppy joe mix which really keeps me full for some reason with the band. The puddings and oatmeal are good and the hot cappuccino is great too. That's so funny about your cousin's baby. I've only ever met one other Britt. When I was little I wanted a "normal" name but now I like it a lot. Keep me posted on your surgery! Britt