Question:
My insurance told me that WLS is not covered under my policy!

Recently I contacted my insurance company, (I work for a company that is self insured and BCBS takes care of the paper work), and they told me that my policy has an exclusion clause for WLS surgery and will not cover this procedure. Has anyone ever had this problem? Can anyone give me some advice? I really want this surgery. I have reached the end of my rope! I just had knee surgery because of my weight problem and I have reflux very bad and I also use a cpap machine to sleep at night. I can't understand why my insurance won't pay for this surgery since I have all of these health problems. It would be cheaper for my insurance to go ahead and pay for the WLS surgery! PLEASE, someone give me some advise. I am so depressed. I guess I will have to go back on my prozac to help my depression.    — Gene F. (posted on August 11, 2002)

August 11, 2002
my insurance will not cover anything like diet pills or nutrition programs or anything like that, but they will cover the surgery if you are morbidly obese. Don't give up, keep searching...
   — candymom64

August 11, 2002
All most all insurance companys are going to tell you that they don't cover this surgery especially because they recongnize it has comestic surgery. How ever you need to fall under the category where you are morbidly obeses. MORBID OBESITY IS CLASSIFIED AS A DISEASE THE INSURANCE COMPANY IS OBLIGATED TO TREAT YOU. BUT THERE A CATCH YOU MUST FIT THERE PERTICULAR STANDARDS IN ORDER FOR THEM TO PAY FOR IT. CALL THEM FIND WHAT THEY ARE DO'NT TELL THEM YOU WANT THIS SURGERY JUST TELL THEM YOU ARE INTERESTED IN LEARNING ABOUT Who qualifys for this procedure under there policy. Trick them be one step smarter then they are. also your going to need a letter of medical nessity from a doctor.
   — sheri B.

August 11, 2002
Gene, if your employer is self-insured, then they can tell the insurance company to pay for this surgery. Talk to your human resources department. It may be just as simple ast a phone call. If not, fight it all the way! Good luck, Ginger.
   — Ginger N.

August 11, 2002
Gene, my insurance too is self-funded. I was also told by the insurance company that wls was not covered, but I found out that it is covered! Look at your exclusion in your health benefit book (I waited weeks before I did) and see EXACTLY what it says. Mine specifically stated: Treatment, instructions, activities or drugs (including diet pills) for weight reduction or control, except for the diagnosed condition of morbid obesity. Notice it says EXCEPT for conditions of MO, that is what qualified me. Also, when talking with your insurance rep, find out who is the person for your company. It does no good to talk with whomever they give you when you call in, specifically ask for who takes care of your company. That too sped up my approval process. Good luck to you!
   — Click

August 11, 2002
I would call them again and ask them if they cover it if it is medically necessary. I did the same thing you did and called mine and was told it was a cosmetic elective surgery so they didn't cover it. Then I found out a co-worker had the surgery and asked her how. She told me to call again and ask them if it was a medical necessity if they would cover it. It did and I had the surgery in april of this year.
   — stacey1273