Question:
Employer did not choose obesity treatment option

I just contacted my insurance and they said that my employer did not choose the obesity treatment option. What do I do now?    — hunterholt (posted on April 17, 2009)

April 17, 2009
I don't know if I really have much of an answer for you. Talk to your PCP and see if they think you would benefit from the surgery and if you have high blood pressure, high cholesterol, sleep apnea, high BMI anything that is weight related and you have it documented the insurance may still pay for it. See if your PCP will write a letter, you write a letter and make sure all the weight loss things you have tried are listed along with the medical. If you have seen a surgeon already ask him. They may be able to get you approved or at least know what to do. Most of them are pros at this sort of thing..... Best of Luck to you....Donna
   — gonnabethinfinally

April 17, 2009
I would try to appeal as Donna has stated above. The hospital where I work has Anthem Blue Cross for their employees which has plans that include WLS. When getting the contract for their employees the hospital specifically excluded coverage for WLS from the agreement. Several nurses I work with have co-morbidities and/or BMI greater than 45 and were turned down. The insurance company told them that there was no doubt they met Anthem's criteria but the employer had refused WLS as part of the contract so there was no coverage. Several of us are campaigning with the hospital board trying to get that changed on the next insurance contract but that will be January 2010. (I am part of an independent physician group with a contract to provide services to the ER therefore not an employee. My insurance is through my wife, who is a teacher, and that insurance did cover my surgery.) I am trying not to be pessimistic about your chances and I would definately do what Donna suggested as our experience here might not be the same for you. One of the nurses I work with paid out of pocket to have vertical sleeve surgery done which she chose because of less malabsorption issues and it was less expensive than bypass. Hang in there. Kevin
   — hapkidodoc