Question:
My insurance is BC/BS of AL and has an exclusion.

I don't mind paying extra for a rider to be added, but is this going to make everyone that works there insurance go up, because if it does, I can't see the HR dept. being much help to me. Also one lady said that her BC/BS had an exclusion but her paid because of co-moridis, can you explain that?    — rachelb34 (posted on January 20, 2008)

January 20, 2008
Most insurances still do not pay for weight loss surgery but if you have high blood pressure, high cholesterol, edema, migraines, etc those are co morbidities and if they are documented in your medical records as being a result of your weight--your insurance will pay if you have the right documentation.--Karen
   — Karen M.

January 20, 2008
Insurance companies cover primarily RNY surgeries on two factors. One is a BMI that is greater than 40. Second, if the BMI is less than 40, some co-morbid conditions must exist. These include diabetes, hypertension, elevated cholestorol counts under medication, sleep apnea, joint problems, and possibly others. My BMI was 39.5, but I got surgery because I had sleep apnea, and was taking blood pressure and cholestorol medictions. Not every insurance company has the same qualifications0--some may say 2 co-morbid conditions, others may state 4, etc.
   — Dave Chambers

January 20, 2008
From speaking to my HR Reps, it not the insurance company that elects not to cover the surgery, it's your employer. The employer is responsible for paying the premiums and they can elect to pay for it or not. As another posted stated, although there is an exclusion; the company will have to cover if it having the surgery is "medically necessary." If you think about it the MONEY ASPECT; insurance and pharmacy companies don't want us to have the surgery because it keeps them in business and keeps us buying medications for the various ailments we have to deal with on a daily basis in order to make it from one day to the next. Oh I'm sure the insurance companies don't TALK employers into covering the insurance; but companies are starting to see that the successes of the surgery decreases the number of sick days taken by a morbid obese employee. They are starting to come around. Also the states need to start coming around by enacting legislation that will require a company to cover weight loss surgery. The State of Maryland has such a law and the employer must employ at least 50 people. I think as WLS becomes more and more successful; more states are going to implement legislation (with our help) to make such coverage mandatory. I suggest those who live in states that do no have such legislation write your local representative to see what can be done to implement and pass such in your state.
   — the7thdean

January 20, 2008
I also have BC/BS. Mine also had an exclusion. They exclusion said that my insurance would not pay for weight loss surgery, except in the case of morbid obesity. It did not state any co-morbidities, only morbid obesity. I was approved on my first submission. My doctor knew what the insurance company was looking for, so all of our ducks were in a row. I was approved within 4 days. Good luck!
   — Debbi S.

January 21, 2008
I have blue cross blue shield and it has an exclusion and I was told no because we are fully funded. Anyone else have that. I have an exclusion and the refused and I also have medicaid and am waiting on that. Mine Antheim of Mo.
   — dawnspaints

January 21, 2008
I am very thankful for you asking this question because the answers you have received have helped me as well. My insurance is through United Healthcare and I also have an exclusion to WLS on my policy. I was under the impression that if there is an exclusion, there is NO CHANCE of the surgery being approved. Maybe there is a chance......Thanks again.
   — Lisa L.