BCBS but employer opted out

[23Stacy 0]

My BCBS is through the hospital I work for. The hospital has opted not to pay for bariatric surgery. My question is, who do I appeal to? If I have my doctors send letters, what department or job title do they send it to? The insurance company won't help because they say it is my employers choice. Any suggestions appreciated.

[GradyCat 3,695]

I don't think there's an appeal level there for you if your employer opted out of that specific coverage under your plan

[Briswife15 890]

I agree with Gradycat. It is not like they cover it but denied you. Then you could appeal. If your employer just choses chooses not to to purchase that coverage you are kind of stuck. So sorry! Maybe ask HR if they would consider adding it next time they purchase their coverage. If enough folks ask maybe they will cover it.

Sent from my SM-N960U using BariatricPal mobile app

[Sosewsue61 3,185]

What state are you in? Depending on income levels you might qualify for assistance through a different route? Could you sign up for ACA and opt out of employer insurance for one year or get a rider added to BCBS on your own and wait the required time before allowed surgery?

And it's insane that a hospital opted out of bariatric coverage.

Edited April 25, 2019 by Sosewsue61

[23Stacy 0]

Thanks all! That's what I figured. I am planning to self-pay but my husband wants me to try to appeal first. But as one said, I can't really appeal as it wasn't a specific denial.

[Briswife15 890]

I'm glad to hear you will self pay and not let this stop you!! Good luck with your journey!

Sent from my SM-N960U using BariatricPal mobile app

[ItsABearDance 21]

I don't think you could appeal since they simply aren't covering the procedure. You may be able to reach out to whoever handles benefits and let them know how this effects you so they could consider opting in in the future for the benefit of your coworkers, though?

[23Stacy 0]

I am actually considering this as I have a coworker who needs it and cannot afford it. I think it's a travesty it isn't covered.