Approval if insurance doesn't cover wls?

[Javamama74 0]

Hey all. I have been lurking around for several months now, but haven't posted. I could really use some feedback. Well, my heart is really set on getting sleeved. In addition to being obese, I have a Rheumatoid Arthritis and Fibromyalgia. I have already seen my primary doctor and gotten her approval and referral to an endocrinologist next week. However, when I called my insurance they said that my employer doesn't cover wls (I have Blue Cross Blue Shield of California). Has anyone gotten their sleeve approved after being denied? Not even sure if this is possible, but figured I'd ask. Thanks!

[Chele H 427]

It's not a matter of being denied, it's a matter of your employer having a WLS exclusion. Even with your health issues unfortunately exclusion is an exclusion. Maybe you can talk to your HR person about changing the policy?

Good luck, I hope you things go well for you.

Edited June 22, 2014 by Michele H.

[Kindle 8,667]

My insurance specifically excludes any treatment for obesity, including counseling, weight loss diet programs and surgery. I pay for my own individual plan and I looked at switching, but no company in my state offers an individual plan that covers WLS. So like Michele said, it's not a matter of being denied, it's something that's just not covered. It's like asking your car insurance company to repair your car after hitting a deer if you only have liability. It's just not an option with your current plan. It's a bummer.

Edited June 22, 2014 by Kindle

[LumpySpacePrincess 594]

Some employers have an option for you to purchase additional coverage on your plan, but I'm not sure how common it is. You can also call the insurance company directly and ask them about how much more per month it would cost for an add-on plan that might cover bariatrics.

When I started looking into it, my former plan didn't cover any sort of weight loss help, even therapy. I opted to buy a plan for six months and pay the premium out of pocket. It was expensive ($900 per month because of my health issues), but it allowed me to have a plan that covered my surgery, all my pre-op work, and aftercare for three months. It was expensive, but completely worth it.