PLEASE SOMEONE HELP!!

[Cristal2star 0]

Hello everyone... i just recently was put on my husbands ins. and looked to see if there was a way to get the lapband surgery. When I was reading it over I seen there was an exclusion that they do not cover services and supplies related to obesity, including surgical or other treatment of morbid obesity, this right away made me unhappy. I am 28 years old soon to be 29 and 5'6 and 396 pounds. I would say that I am WAYYYYYYYYYYYYYYYYYYYYY over weight. I dont think I can afford to go pay for it out of pocket at the moment. What I wanted to know is does anyone else have BC/BS of Texas PPO and have you gotten approved. Please all help would be nice . Thanks in advanced I would love some good news right about now.

[HeatherinCA 10]

Hmm you have a PPO and they don't cover it? Maybe call them up and make sure...

[Cristal2star 0]

Hmm you have a PPO and they don't cover it? Maybe call them up and make sure...

That is what it says in the handbook they gave me. I had a few people tell me they did get the surgery with TX BC/BS PPO. I am hoping that once the ins kicks in on April 1st and I start going to the doctor that it will be approved.

[xxm4ndaaxx 2]

That is what it says in the handbook they gave me. I had a few people tell me they did get the surgery with TX BC/BS PPO. I am hoping that once the ins kicks in on April 1st and I start going to the doctor that it will be approved.

call the company.. theyll tell you if they do or not, and any requirments they have.

people kept telling me mine wouldnt cover it, and after weeks of stressing over it, i finally called and found out that they did indeed cover it 100%. i wish i would have just called sooner.

[Acadia 20]

It could be that your husband's company put that exclusion clause in. It's not specific to insurance but the employer. They decide if they'll cover it or not. If it's excluded in the handbook then chances are, you have absolutely no recourse to get approved.

[Ponderer 14]

I have what I consider to be very good insurance with Regence PPO. Any treatments, surgery, etc. for obesity is clearly outlined as an exclusion with our policy as it is how my company chose to do things. If they have written that they will not cover it.....it is not about if a BMI qualifies or even if it is considered "medically" necessary by one's doctor....chances are it will not be covered. When companies purchase medical insurance for group coverage they have to customize and choose various plans and when things like obesity treatment are excluded that is typically done to keep the fees down for all. I know where I work I am in the minority and can understand why a small company like the one I work for would opt to leave this out and keep rates low. On one had it drives may crazy that I have spent as much as I have for my insurance over the past 7 years and am about to pay $15,000 out of my own pocket for lap band. On the other hand....it would also drive me crazy to think that everyone in my company was spending thousands of extra dollars for a service they were never ever going to use. It can feel like a catch 22 but I guess I want to look at the cup half full.

[losetobemeagain 9]

call just them because my insurance co. website said they didn't cover it, but I called twice myself and had to different surgeons office's call and they do cover it... I think when they make some of these handbooks and websites it more of a general type thing instead of an indiviual depending on your company's policy...