Question:
My boss doesn't think WLS falls under FMLA because it's elective.
How can I make sure it is covered and prove to him that it is also? — Joy J. (posted on January 9, 2004)
January 9, 2004
If your insurance is covering the surgery then its "MEDICALLY
NECESSARY"!!!! They don't cover 'elective' surgeries! Your boss needs
to be 'enlightened' and your the one to do it. You can also ask your
insurance co. They might know about FMLA. What about Short Term Disability?
Is that offered to you? I had that when I was recovering and it saved my
butt!
— Kris T.
January 9, 2004
That should be covered. FMLA can also be used for you to take care of a
family member. If not sure, contact the labor relations in your state or
the federal office building for labor relations. FMLA is federal and not
a state, county or city benefit. ted
— ted M.
January 9, 2004
I used FMLA at my worksite and it is covered under FMLA. Also my superviser
didnot even know the reason for my surgery only the FMLA counselor did.
Good luck
— Robin B.
January 9, 2004
I asked my HR rep that handles FMLA because I thought there might be
exclusions regarding 'elective' surgery. However, any surgery that impedes
your ability to return to work will qualify. So yes, it fell under FMLA.
As a matter of fact, your boss doesn't even need to know why or when you
are having your surgery. I would talk to your HR department for piece of
mind. Good Luck! Lisa -155lbs
— LisaTaz
January 9, 2004
I used FMLA for my knee replacement surgery, which, I guess, could be
considered elective. I could have elected to not have it and risk being in
a wheel chair. You could elect not to have WLS and risk dying from
obesity-related medical problems. Sorry, I tend to get on a soap box as I
do not consider WLS elective - it is a medically necessary surgery.
— Patty_Butler
January 9, 2004
I work in HR and YES it is covered under FMLA leave. Please remember that
this is a 12 week unpaid leave and that it is given to you by LAW, so dont
let anyone tell you that because its elective its excluded. Its the LAW!
— lesleeloo
January 9, 2004
Just a note on terminology here. The term "elective" simply
means that the surgery is not emergency. It does not refer to the
necessity or effectiveness of the procedure; "elective" means
only that the surgery can be scheduled in advance. Therefore, heart bypass
surgery is also elective, as is cancer surgery, knee replacement surgery as
previously noted, and any other surgery that is not an emergency. FMLA
does not distinguish between elective and emergency surgery. You are
entitled to FMLA for any serious medical condition that prohibits you from
working. WLS is certainly that. (I'm an HR director with 25 years
experience.)
— Vespa R.
January 9, 2004
He is WRONG
— Kriola
January 9, 2004
He's wrong http://www.dol.gov/esa/whd/fmla/
— RebeccaP
January 9, 2004
Here you go, quoted directly from the law......
(a) For purposes of FMLA, ``serious health condition'' entitling an
employee to FMLA leave means an illness, injury, impairment, or physical
or mental condition that involves:
(1) Inpatient care (i.e., an overnight stay) in a hospital, hospice,
or residential medical care facility, including any period of incapacity
(for purposes of this section, defined to mean inability to work, attend
school or perform other regular daily activities due to the serious
health condition, treatment therefor, or recovery therefrom), or any
subsequent treatment in connection with such inpatient care;
— RebeccaP
January 9, 2004
I was covered under FMLA and short-term disability.
— jellybean0605
January 9, 2004
You might also want to show him this section as well.....LOL. 1) An
employer is prohibited from interfering with, restraining, or
denying the exercise of (or attempts to exercise) any rights provided by
the Act.
(2) An employer is prohibited from discharging or in any other way
discriminating against any person (whether or not an employee) for
opposing or complaining about any unlawful practice under the Act.
— RebeccaP
January 9, 2004
I, too, was covered under FLMA and collected short-term disability. Best of
luck to you! Barb 4/07/03 235/140/130
— Barbara C.
January 9, 2004
My husband was allowed to use FMLA to stay home with me for 2 weeks after
surgery. We did not think they would approve it but they did and they are
the Postal Service so that says something. LOL
Good luck!
— TheresaC
January 9, 2004
I used FMLA for my surgery and was out covered for 6 weeks and paid through
my companies short term disability. Only requirement for FMLA was that I
have the paperwork submitted, if possible, 30 days in advance as well as
the disability paperwork. It is not your employers decision to say whether
or not this surgery is elective and as a previous person said it is only
considered elective because you are scheduling it in advance and not
getting emergency surgery, such as an appendectomy, done.
— SassySamara
January 9, 2004
Hey there, my previous administrator pulled that BS on me 3 days before I
was to have my WLS. She said that it WAS an elective procedure and that I
would have to wait until SHE thought I could take off. OH WELL, I informed
her very quick that if my insurance hadn't deemed it a medical emergency
and gave me a date the day of approval, it would have been an elective
surgery. I had my MD & surgeon fax me a copy of my approval letter
along with my numorous problems, THAT was NOT any of their business. I
also told her that her little trip to the ICU a few months before had to
have been an elective procedure for her because she CHOOSES to smoke and
she made herself sick, ummm, she actually collapsed a lung from smoking.
UH, You don't have to smoke to live, but you have to eat to survive. A
little difference. I also told her that out of the 11 years that I had
been with that company, I had paid my insurance premiums myself with no
help from her. I had worked whatever shift for any length of time,
pregnant or not, worked 12 hour shifts on a broken foot for 16 months, had
a stroke when I was 25 years old, there at work, missed 2 weeks and came
back on a quad cane, I kept telling her stuff until she got sick of me.
Then I told her that it wasn't up to her in the first and last place. Then
I proceeded to tell her that if my surgery was the only thing she had to
worry about, she had a sad and miserable life. She said, "What would
we do if you died?" I said what would you do if I fell out with
another stroke or just walked out of here and never came back? As far as
that goes, FMLA ain't nobody's business except the employees, to be used
for whatever you deem necessary. I don't know what the best answer is, but
I know I was very miserable, unhappy, frustrated, hurt like hell all of the
time, ill as a hornet, and mean as a snake and I didn't care who's feelings
I hurt or who I pissed off as long as I got my surgery. The end of the
conversation ended when I threatened to turn her in to the labor board for
not allowing her employee to use her OWN time as she needed. Um needless
to say I'm almost 14 months out from RNY, down 140lbs to 130 lbs from size
24/26 to a size 6/8 depending on how it's made. I kindof don't take no for
an answer. Good luck.
— Leigh G.
January 9, 2004
it isn't elective if your doctor says it is medically nessesary. and that's
a fact...so your boss is wrong no matter what her veiws are.
— franbvan
January 9, 2004
IT DOES FALL UNDER THE CATEGORY! My husband filed for his two weeks after
I had surgery. Basically it allows him to leave work without getting in
trouble in case something were to go wrong. In the FMLA paper work there
are a bunch of questions you must answer to determine whether something is
covered. One of the question is "Will the patient require on going
medical care as a result of whatever" the answer is YES! Because for
the fist 6 months post-op you will be seeing the surgeon. That means you
qualify!
— Renee B.
January 9, 2004
...but, and employer with under 50 employees within a 75 mile radius does
not have to provide FMLA to it's employees. This is in the opening heading
of the act.
— [Deactivated Member]
January 9, 2004
It is covered under FMLA - because it is medically necessary, also in the
future YOU DO NOT HAVE TO TELL YOUR BOSS WHAT KIND OF SURGERY YOU ARE
HAVING - You have the right to privacy. The doctors and medical staff will
respect and list the surgery as admominal surgery or by the medical CPT
Code. If your company refuses list you under FMLA you have a labor law
suit! Good Luck ON your surgery!
— Anna M.
January 10, 2004
I work for the Dept of Justice. I am a supervisor and WLS is covered under
FMLA if your doctor writes a letter to that effect. I have used it twice!
I am invoking it again to cover my panni and hernia repair at the end of
the month. The government follows FMLA guidelines to the letter and so you
know that this is covered if I used it. Many employees in my unit have
invoked it for various reasons. All that is needed is a letter from the
doctor stating that you are having ABDOMINAL surgery and that you will be
needing 6 wks (or whatever) to recover. Also have him state that you will
be required to have follow up care and appts for the next year! Very
important because once you invoke it, you can use it however you need
without doctor's certificate. You can use it an hour, a day, a week, 3
hrs, whatever you need. Remember it is Leave Without Pay but if you have
worked 1250 hrs for the company in the last year, it is an ENTITLEMENT, not
a courtesy that your supervisor "kindly allows". Boy, you can
tell this is a sore spot with me because I can't stand supervisors that act
like they are in control of your personal life. FMLA is a law that was
passed during the Clinton administration and it is not something that
companies can ignore. Once again it is an entitlement! Tell your
supervisor to check the guidelines and she will see that your certainly
qualify. Aside from the fact that WLS is not elective, she is wrong!!!
Good luck and stick to your guns. Never give up~
— Mylou52
January 12, 2004
It is. I work in a law firm and used FMLA when out last year.
— Dawn P.
January 12, 2004
WLS is covered under FMLA if the surgery (any surgery elective or not) is
deemed "medically necessary". That's what our benefits
administrator told me. She said give us a Dr note and you can use FMLA with
no problem - She said if she didn't give me FMLA coverage with the Dr's
note, she believed that she would be in violation of the law and I could
sue the company.
— M B.
January 22, 2004
several points to make. If your employer offers FMLA they have to give it
to you. the employer is NOT the one who determines medical necessity, YOUR
DOCYOR determines that. My employer tried this cr*p on me when I was having
surgery on my achilles tendon. I went to the labor board and got the full
info. they cannot deny you if your doc says it is med necessity. actually
it is the recvery that determines if you are able to work. Not the
procedure being done. For example, I am having a tummy tuck It is not up to
my employer to decide if I need this surgerry. However My surgeon says I
have to be off X # of weeks to safely recover from this procedure. My
employer has to respect that. period. SECOND ~ THIS IS NOT AN ELECTIVE
SURGERY ~ & dont let them even try to tell you that it is. You are not
doing this for cosmetic reasons. You are doing this cause morbid obesity is
a disease that is DEADLY, the surgery is a treatment for a life threatening
disease.
— **willow**
January 23, 2004
due to an email i recieved I want to clarify. FMLA is family medical leave
of absense. It guarentees that for those who work for a company that has
fmla that your job will be saved, it does not guarentee any pay, or
insurance coverage during that leave, only that you can have the time off
and get back a comparable job at the same pay level.
— **willow**
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