BCBSTX- approved but Hubby's Employer X'd

[Musickmaker06 0]

We have BCBS of TX and my weight loss surgery was approved, but we have the insurance through my husbands employer and they are requiring extra hoops including proof that I have been obese for 5 consecutive years. The problem with this is that I had achieved a large weight loss about 3 years ago. And gotten to a healthy BMI only to gain it all back. I've done this my entire life... Up and down. You would think they'd WANT to see that I've had success losing weight before?!!

Anyways, is there any way to get around this? The years previously and since I've had a BMI of at least 38-42.

Thanks!

[Champ715 207]

I've never heard of an employer doing this. Is that even legal? I have BCBS through my employer and I didn't even have to tell them what kind of surgery I was having. I just told my boss I'd be out for a week for surgery but nobody asked any questions past that. It seems like if you met the insurance requirements and the insurance company approved you then your employer should be able to introduce their own requirements or caveats. I would definitely try to get some more information on this because it sounds fishy to me.

[reree6898 1,164]

I don't know how it's legal for an employer to even question the surgery let alone make additional requirements.

[Sharon1964 2,530]

If it's self-insured and BCBS is the third party administrator, then they have hired BCBS to handle their authorizations and claims. If this is the case, BCBS couldn't have approved it without the additional restrictions.

So who told you and how did they tell you (letter?) about the additional requirements?

[Musickmaker06 0]

The surgeons office is who called to tell me that I was approved through BCBS but with these stipulations. Should I dig further?

[hockeyfan7 249]

Yes, I would dig further. It sounds like BCBS put on the additional stipulations. I'd find out who said you needed to prove that and then have your PCP write a letter.

[Daisee68 2,493]

Agreed. Employer cannot overrule even if self-insured. Get a copy of what drs office received.