Major issues with bcbs of michigan and employer excluding bariatric surgery

[49ermommy 0]

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:

[honk 780]

I don't see them changing the policy because it would need to be company wide. I would however call the insurance directly and see whether the entire surgery is excluded or as you mentioned staying over night.

As you enter open enrollment usually done in the fall see if the company has several insurance companies to pick from. The exclusion could be different between insurance companies.

[JillianRN 0]

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.:w00t:

I have the same insurance and was just banded Oct 8, 2010..My husband's company did not have that clause. Therapies may include fills. I would work through the process and see where it led./That includes going to a seminar, getting your Primary Care MD to write a letter on your behalf detailing your co-morbidities, and how you would benefit from this procedure. I am praying for you in your journey, that God will make a way for you.