49ermommy

I need some advice, I have Blue Cross Blue shield of michigan and went to a consultation for the lapband, the lady verifying the coverage did not think that I would have a problem getting the surgery but once she called they told her there was an exclusion against bariatric surgery from husbands employer. I am looking through my policy as this is new insurance to me and I see nothing under exclusions for bariatric surgery however there is a clause under exclusions that says therapy or hospital admission for weight control, but that doesnt not seem like it would apply to my lapband procedure, and I was planning to have it done as an out patient procedure. What can I do if this is a medical necessity? I have several pre existing conditions due to obesity, is there a way around this? The lady at the WL surgery center suggested my husband talk to his HR dept at work to see if they can change his policy, but what would be the odds that they would do that? Any suggestions on how to fight this would be really appreciated.:smile:

If my insurance company never game me the handbook disclosing the exclusion of my medical policy which include excluding anything that has to do with obesity and bariatric services, can I seek legal action? When I enrolled into my insurance with BCBS of MI all they gave me was a 2 page pamplet which listed the coverages and copays/deductables, one of which said outpatient procedures, I assumed that bc my lapband was an outpatient procedure it wld be covered, however after my dr called into to get approval they said that bariatric services was an exclusion in the policy, I am now dealing with my husbands employers benefits dept and they are referring me to the agent/broker whom we signed up with during the open enrollement, they are acknowleging the issue I have and are looking into what they can do but no one is getting back to me, does this sound like I might have a case if they decide not to change the policy to add bariatric services?:cursing: (any advice would help as im just trying to get this procedure bc it is medically necessary) Thanks Erika