Has Anyone Convinced Or Gotten Their Work To Add Bariatric Surgery To The Insurance

[cloudsprincess 2]

Has anyone gotten their job to add weigh loss to the health insurance policy? I have an exclusion on my current plan but the company is shopping for new insurance for Dec 1st. If you have what did you do or say? I'd love to convince my job to add it instead of excluding it. Please help?

[AStephenson 159]

Hello-My husbands employer (Im on his plan) also excludes bariatric services. I have called both his HR person (no response) and BCBS to ask about this. BCBS told me that even though it is an exclusion on our group plan I could still appeal it, but he said he didnt know how successful I would be. I've gathered a few things, planning on doing my own appeal, but I have no idea how to proceed and just decided to look into selfpay and having surgery in Mexico. Right now Im saving money and have resigned myself to a VERY long wait to raise the money needed for self pay. Maybe you could appeal? I may still try, nothing else going on while I wait, squirreling away my pennies! If I get anywhere, I'll be sure and let you know!

[IsB 209]

What's sad is that the employer barely saves any money with this exclusion. I work for a small company and coordinate the health insurance for my firm. The money we would have saved for 25 people with the exclusion was under $200 for the year. We lose a lot more than that from weight related health issue absences. Even for a large company I doubt the exclusion is worth it if they ran the numbers.

[O.T.R. sleever 3,386]

What's sad is that the employer barely saves any money with this exclusion. I work for a small company and coordinate the health insurance for my firm. The money we would have saved for 25 people with the exclusion was under 200 for the year. We lose a lot more than that from weight related health issue absences. Even for a large company I doubt the exclusion is worth it if they ran the numbers.

Under $200/yr per person? Even then the number sounds a bit low. According to our benefits department the exclusion of elective surgeries equates to anywhere from 35-90 per month per person depending on the plan they choose. And this is from a company with over 4000 employees, I would think that that fact alone gives them better bargaining ability.

[Teriiann 34]

We have BCBS of Florida they cover the sleeve now as of aug 1 but we have to pay an extra 3000 plus co pays and deductibles ect. Why I mean surgery is surgery it all relates to your health.

[O.T.R. sleever 3,386]

Why I mean surgery is surgery it all relates to your health.

A Tummy Tuck is surgery too. WLS is an elective surgery intended to treat a self inflicted ailment. Insurance isn't designed to pay for anything you want, it is supposed to be for necessary accidental or uncontrolable events. I hate to say it, but getting fat doesn't fall into accidental or uncontrolable categories.

[Teriiann 34]

Yep understand that, just so frustrating...(

[Izuri 428]

A Tummy Tuck is surgery too. WLS is an elective surgery intended to treat a self inflicted ailment. Insurance isn't designed to pay for anything you want, it is supposed to be for necessary accidental or uncontrolable events. I hate to say it, but getting fat doesn't fall into accidental or uncontrolable categories.

I think that it would be nice to see a movement toward preventative care. We get so focused on curing people that we forget that we could avoid a number of diseases and ailments by pushing more preventative care. There is some movement toward it, but in the long run we could save ourselves far more money by preventing the disease in the first place. My surgery cost my insurance company about $20,000, but to pay for doctor visits, surgeries/amputations for necrotic ulcers due to noncompliance, hospitalizations, medications, etc for if I got diabetes would far outweigh the cost of surgery. But type 2 diabetes is preventable in a lot of people - does that mean that it should still be under the uncontrollable category? Or alcoholism? The list could really go on and on of self-inflicted ailments that are considered necessary by insurance. Personally, I don't feel that this is all that much different. Some of us are addicted to food, some of us have mobility limitations, etc. It may start out as something that is elective, but obesity is a large risk factor in an endless number of diseases.

I do agree that that's how insurance companies see things like this nowadays, but I hope in the future we can see a change to them covering more preventative care - not just weight loss surgery, but other measures that help keep people healthy.

OP: I would try to see if your HR has any kind of appeals process. The worst that they can do is come back and say no. I know that I - along with probably a number of people on this board - would be very interested to see the process and the results if you do. I'll keep my fingers crossed for you.

[Teriiann 34]

Very well said Izuri!!!

[IsB 209]

Under $200/yr per person? Even then the number sounds a bit low. According to our benefits department the exclusion of elective surgeries equates to anywhere from 35-90 per month per person depending on the plan they choose. And this is from a company with over 4000 employees, I would think that that fact alone gives them better bargaining ability.

Not per person. It would have saved us $200 for the year for 25 employees. The employees only get 2/3 of the single premium so the cost to our firm is less than it would be to a company who pays more of the benefit premium. The cost to the employee who pick up a 1/3 of their single premium and all of their dependents premium would be higher but we are instructed to only look at the cost to the firm. Even with that though the benefit is nowhere near $35 to $90 per month per person. Maybe it's different in different states?

[AStephenson 159]

WLS is an elective surgery intended to treat a self inflicted ailment. Insurance isn't designed to pay for anything you want, it is supposed to be for necessary accidental or uncontrolable events. I hate to say it, but getting fat doesn't fall into accidental or uncontrolable categories.

Our plan will cover drug and alcohol counseling and treatment, but not food addiction. So if I became an alcoholic and fried my liver (self-inflicted) I would have coverage to attempt to regain my health, but nothing for nutrition counseling, medically supervised diets or stronger methods if those fail.

Just really smacks a bit...hard!

[IsB 209]

A Tummy Tuck is surgery too. WLS is an elective surgery intended to treat a self inflicted ailment. Insurance isn't designed to pay for anything you want, it is supposed to be for necessary accidental or uncontrolable events. I hate to say it, but getting fat doesn't fall into accidental or uncontrolable categories.

Pregnancy which is often planned doesn't fall into it either. Nothing is black and white which is why insurance companies do cover these procedures as long as that insurance is paid for.

These are big public companies. Anyone can look up their financials and see how they're doing. In general health insurance has been a pretty good business to be in. Even if they do have to cover some major surgeries they are more than making up for it with the healthy people enrolled. The family on my plan that just goes for an annual physical each year still pays the insurance company the same $1500 a month in premiums that I do.

[O.T.R. sleever 3,386]

Pregnancy which is often planned doesn't fall into it either. Nothing is black and white which is why insurance companies do cover these procedures as long as that insurance is paid for.

These are big public companies. Anyone can look up their financials and see how they're doing. In general health insurance has been a pretty good business to be in. Even if they do have to cover some major surgeries they are more than making up for it with the healthy people enrolled. The family on my plan that just goes for an annual physical each year still pays the insurance company the same 1500 a month in premiums that I do.

Have you priced a health plan on the open market that covers maternity? Good luck finding one that covers it from day one for less than 1k/month.

Besides bringing life into this world is quite different & once you get to that point it isn't exactly elective.

[Ready4success 380]

At my previous job, people were hiring on to to get weight loss surgery, and were then leaving after surgery. They were basically in and out of the door in 6 months or less (nurses have benefits from day one and others get it after 3 months). After they discovered the trend, they put an exclusion on the policy that makes everyone eligible after 6 months, so now you have to work for them for 6 months before they'll cover any type of WLS. The good thing is that it's still covered, though.

[Ready4success 380]

At my previous job' date=' people were hiring on to to get weight loss surgery, and were then leaving after surgery. They were basically in and out of the door in 6 months or less (nurses have benefits from day one and others get it after 3 months). After they discovered the trend, they put an exclusion on the policy that makes everyone eligible after 6 months, so now you have to work for them for 6 months before they'll cover any type of WLS. The good thing is that it's still covered, though.[/quote']

Sorry, forgot what I was getting at. Would you consider getting a part-time job with benefits somewhere that WLS is covered? Just a thought.