Excluded From Benefits?

[margarita81 4]

Has any one had it where the insurance company says that any bariatric surgery has been excluded from plan? If so, has the doctors office fought it and ended up getting approval or that was it, No more trying. please advise...

[happy1957 138]

I am not a victim of that scenario, but my sister was. The insurance company told her to go to her HR department and have that rule changed when the contract is

renewed, she has to wait another year..

[Losin4good 691]

I tried for 3 years. Its the employer who excludes it from the plan to keep costs low. There is a difference in them denying it and it being excluded. If its excluded you have no chance unless the next year the employer decides to not exclude it. I had to be a cash paying patient

[AngelEyesInNJ 187]

It is also excluded from mine, my employer said they would look into it but here I am with still no answer. I didn't let that stop me though I am going to Mexico to be sleeved by Dr.Garcia in Nov

I did find something online while searching it may be helpful to provide to your employer.

http://www.bariatric-surgery-source.com/lap-band-insurance.html#business_reasons

[5DoxieMom 87]

My health insurance provider, Pacific Source, excludes all WLS, AND any complications that may arise from it, should a person go out and have surgery on their own.

[AngelEyesInNJ 187]

My health insurance provider, Pacific Source, excludes all WLS, AND any complications that may arise from it, should a person go out and have surgery on their own.

There isn't a way around it say like ER coverage? I know each company is different but I called up mine and asked what if I need to go to the ER would it be covered and I was told yes. *knock on wood I wont need it *

Maybe that is something you could ask? I know this is frustrating.. I wish you the best of luck!

[5DoxieMom 87]

I asked. And if I needed my gallbladder removed and it could be directly related to WLS, they will not cover it. But, my insurance has no idea I had WLS, because my PCP (whom was totally on board with WLS) is very forgetful, and 'forgot' to mention it in her dictation, so it has never made it onto my list of diagnoses, (wink). I'm 6 months out, so I'm feeling pretty safe. One benefit of being a slow loser, is its easier on the ol' gallbladder!

[margarita81 4]

Thanks for all the replies...hopefully something could be done....