Anyone successfully convince their company to add WLS to coverage?

[MacMadame 81]

I just found out that my company -- the one with killer benefits that include just about everything including IVF and all sorts of alternative treatments -- excludes WLS from their medical plans. I'm pretty upset about it because, given their generosity on everything else, and their emphasis on people improving their health, I am convinced it's a matter of prejudice and ignorance.

Anyway, I'm thinking about writing them a letter. Our Open Enrollment period is in 5+ months so I'm guessing they are working on what the coverage will be right now. If I could convince them to add this coverage, it would help a lot of people.

Has anyone been successful in doing this?

[mia31771 0]

My company has a total WLS exclusion too- I didn't even think of writing them a letter but I think that is a great idea!! It can't hurt to ask and you might even get them to allow it! I was self pay but could only afford that after my mother passed away with my inheritance money. I say go for it!

[MacMadame 81]

I'm going to make the argument that since they are what is called a self-insurer that WLS would end up being cheaper for them in the long run than paying to treat my high blood pressure, my inevitable diabetes, my plantar faciitis, weight loss pills (which are covered) to curb my appetite, plus anything else that comes up later on because of my obesity.

A "self insurer" company is one that doesn't pay the insurance company premiums. Instead, they put the money they take out of our paycheck plus a whole bunch more and put it in a special account. Then, when the insurance company pays our doctors, they take the money out of this account. This means that if we go to the doctor less, have less prescriptions, etc. that it costs our company less. So they have a BIG incentive to approve the surgery IMO.

In my case, they are spending about a $1000 a year just on my prescriptions for my blood pressure. Plus I have to go for a check up and blood work 2x a year instead of 1x because I'm also taking a potassium supplement. So that's another $1000 a year for the supplement, extra doctor's visit and two sets of lab work a year. That means in 5 years the surgery would pay for itself just by treating my high blood pressure!

I'm not even 100% sure at this point that I want this surgery. But my company is enormous and if I get them to approve it, it should help a lot of people. And if I do go through with it, it will help me. Whee! :eek:

[010308 0]

Just wondering if you went for it? Did you write? Did they respond?

If you haven't yet written I'd say go for it.

[🅺🅸🅼🅼🅸🅴🅺 296]

I'm in a similar position with my employer. The entire time I thought it was UHC denying my surgery but it turns out they were denying it because of extra requirements my employer has. UHC was more than willing to pay for my surgery if my employer didn't have these extra requirements (hypertension and/or diabetes unable to be controlled by meds). So this whole week I've been dealing with the corporate office. The people I'm referred to are really nice and they keep escalating and escalating but heels seem to be dragging or the buck is just being passed around...but at least they haven't said no yet.

to everyone here fighting for their right to live a healthier life!!!

[srknepler 0]

I just started this battle with DH's employer also. I just wrote the HR person an e-mail and asked for her help & opinion.

There offer several different insurance plans (it's a rather large company) for each state, and I asked her if all of the plans had an exclusion??

Is the company aware of the exclusion? can it be changed?

(the lady at the lapband clinic said that their insurance had an exlusion!! LOL no one had noticed it...)

or will they make individual exceptions??

I haven't heard back yet, but I figured that the worst that could happen was them saying NO and I'd be back to self-pay....which is no worse than I was before.

[MacMadame 81]

I didn't write the letter because I found out that there was small print ... it is covered if it's "medically necessary". So I'm going to see how this plays out before I go to HR. I have a call into a surgery group so I should know soon if they are going to just say no right up front.

[NanaRenan 0]

We always focus our anger and hatred on the insurance company, but I've come to understand that it is ultimately the employers choices that affect WLS.

Insurance money is collected from the employee's wages and pooled and someone like Aetna or BCBS, etc. is contracted to MANAGE and disperse the funds according to how the employer sees fit.

I was denied four times -- on the 5th (and final) try my WLSurgeon requested that someone specializing in bariatric surgery look at my file. I had approval in 3 days!

Six months out I've lost a total of 65 lbs and am off of EIGHT meds I would've been on for life. The meds alone would have totalled over $5K just for MY co-pay, not sure what it would cost the insurance. They'll end up saving money on me now that I'm banded.

Employers need to be made aware the healthy benefits of WLS...I'm sure most of them still look at it as cosmetic.