HR dept

March 21, 2004

Ok, a quick run down of my deal so far. I want the LapBand. My insurance is BCBS of IL PPO and I have been denied 1 time and have not appealed yet. I also turned this into the IL state insurance board and they told me basically since my insurance was self funded that they could not help me BUT my best bet would be to appeal through my HR dept that BCBS of IL only managed the insurance for my husabnds employer "Georgia Pacific" and that the HR dept could overturn the denial. Anyone ever went this route? And if SO what did you submit to the HR dept? Did you have any luck? I'm so fustrated I have been working on this since October 2003 and my best friend was approved and is well on her way with weightloss and its just depressing me more....I mean I'm GLAD for her but me being denied sucks!!! I know I'm not the only one either. Anyway any advice would be greatly appreciated. Thanks!!

Alexandra · March 21, 2004

Your company being self-funded gives you a good chance of success, KYAngel. It's your company that makes the coverage decisions in your case, not some impersonal insurance carrier dealing with hundreds of thousands of people.

Assuming you meet the qualifications in general for needing WLS, your next step is to figure out why the denial--did they deny you for all weight-loss surgery in general or just for the Band?

If they denied you for all WLS, you need to convince them that it would be cheaper to pay for your surgery than let it go untreated. In the long run they would likely be paying for other obesity-related conditions, such as diabetes (which is chronic and the costs never go away), hypertension (same), heart problems, sleep apnea and so on. There's no question that the insurance world in general has embraced the notion that treating morbid obesity is more cost-effective than not treating it, so that's your argument.

If they denied you for the Band your argument is even easier. It's cheaper, safer, less likely to create problems down the road (which they would have to pay for).

Your company is primarily interested in saving money. You have to show them that the $15,000 spent on the band now will save them untold dollars down the line. Good luck!!