Question:
What do I do now?

I work for a company that is self-insured and Blue Cross Blue Shield administers the policy for my work. There are over 60,000 employees in my company nation wide. About two weeks ago my doctor sent a letter for approval to BCBS. BCBS approved my surgery so my doctor set my surgery date for Sept. 20. When the hospital called my work to see what the co pays would be, my work said they had an exclusion for WLS and they did not care what BCBS said. My employer said they would not allow this no matter the approval letter said. Has anyone else ever had this problem or can someone give me some advice.    — Gene F. (posted on September 13, 2002)

September 13, 2002
Dear Gene: I have never heard of such cruelty before, but I am not shocked. I can only repeat to you what my fellow wls co-workers told me....Fight for it! It is worth the fight. Contact a lawyer, federal agencies that support your right as a fellow taxpayer, call all the ceo or whatever in your company and either get their policy verified or changed. Be a pioneer if you have to..do what you have to...its your life you are talking about.
   — Rhanda R.

September 13, 2002
Is whoever made this decision aware this is your health? Its possible they are trying to save you, perhaps heard a horror story once or think WLS is cosmeic. You need to educate that individual. Explain how surgery will make you healthier, which gets them a better worker.
   — bob-haller

September 13, 2002
Make sure that you check out the wording of the actual exclusion. That may be the catch and how you can get by this. Also, check when the exclusion was written, make sure they did not throw it in there after they found out about your surgery!!
   — Vicki L.

September 14, 2002
Hello Gene: Similar to you, BC/BS was only the administrator of my husband's insurance policy. The company itself paid. I was fortunate that the company did not exclude WLS. However, please check the wording. When I originally called the insurance company, they stated that they did have an exclusion, but it turned out that the wording stated something like, excluded except in cases of morbid obesity and medically necessary surgery. If you meet the medically necessary criteria, and I am sure you do, you must check to see the exact wording. If it excludes WLS for any reason, you will have to go to the next level. However, I have seen and heard so much misinformation regarding WLS, that I would definitely investigate further. Also, if the exclusion is ironclad, does your company offer more than one insurance plan? If so, consider switching at the next renewal. I know you do not want to wait, but if they are being so obnoxious, I would try to beat them at their own game. Do not forget, you may not really be excluded. The company may just be trying to nip this in the bud, so no one else dares to apply for WLS. Hope this helps. Good luck.
   — Grace H.