VA INSURANCE Wont cover surgery

[refocus 6]

I live in VA. I had my own insurance and it is the best I can get....but VA doesnt have an insurance that covers weight loss surgery. I went on my spouse's insurance this year....its a small company and it also doesn't cover the surgery, that isnt even a rider that could be added to cover the surgery. My question is has anyone that lives in a state that doesnt require the insurance company to include weight loss surgery ever been able to get the insurance company to cover the weight loss surgery or am I just out of luck because I live in VA? Can you ask the insurance company to cover, along with documentation and letter from doctor that it is necessary? Help please...no surgery for VA....

[2goldengirl 2,076]

No, you can't. A benefit exclusion is a benefit exclusion, pure and simple. The reason your insurer won't budge on this is because they'd have to spend all their time reviewing requests for exceptions for everything, not just bariatric surgery. If they covered it for you, that would open the door to having to cover it for a lot of other people.

You do have the private pay option, which includes not having to meet insurance requirements pre-op, just your surgeon's requirements.

There are some people without the benefit for bariatric surgery who have gotten their surgery partially covered if they also require a hernia repair, usually a hiatal hernia.

I'm sorry.

[hollybower 122]

Virginia Medicaid does.

[jhbeck 29]

Many insurance policies in Virginia do cover it. I know there has been an effort to get the legislature to require insurance companies cover it, but no success yet.

But many Anthem policies in VA include coverage. Not sure about the independent marketplace options.

Jess, mom to Ysabel, 6 and Maggie, 3