How does insurance and employer exclusion work?

[Gone4Now 4]

Forgive me - I know nothing about insurance. I am the idiot in the corner selecting my plan by the "Eeeny-Meeny-Miney-Moe" method. I am not proud, but it is what it is....

I am banded, have been since September, and my friend wants to get the band. She has UHC, and was told her plan doesn't cover it. I have UHC through a different employer and they did cover it.

My question is this: Is there any way she can get supplemental insurance that would cover the band?

Was anyone here told their insurance did not cover the procedure, but then was able to get around that somehow?

Also, if it is employer exclusion (I'm certain it is, since mine covered it, but don't know for a fact) how do go about reversing that? Was anyone sucessful in doing that? If so, how?

Thanks!

[Wheetsin 714]

An employer exclusion is when the employer opts out of certain coverages to reduce the overall cost of providing insurance to its employees. When you're facing an employer exclusion, AFAIK, the only real course of action you have is to ask your employer to add the piece it excluded. Not many employers are willing to take on the extra costs (can be significant) because one person wants something done. So my personal suggestion if you're going to go this route is to work with peers who also have interest, do the math, and show them some ROI numbers. I can't say it will have any success, I've never seen anyone come out with good news, but at least it's a smarter way to approach it than, "because I want it." :thumbup:

Do have her check where the exclusion is. Because your UHC plan covered the lap-band doesn't necessarily mean all UHC plans will. Even within my own work building, carrier covered my band under my plan, but others with the same carrier, different plan, are not covered.

I've only seen one person ever claim success and they worked for a small company and knew the owner and had them pull some strings or something like that. *shrug*

Supp plan for lap-band, I don't know enough to say yes or no, but I would guess not very likely. Especially when you're MO, supp plans are VERY hard and can be VERY expensive to get.

LMK if I can guess at answers to any other questions. :tt2:

[Gone4Now 4]

:thumbup: Thanks! Your guesses probably have more education and truth behind them than what's in my little finger!!!

She does work for a small(ish) company, and knows the firm administrator pretty well....hopefully she can take that route and persuade them to add it.

Question about that: Can a company add that for, say, one year, and then change it again later after the procedure has been done?

[Marimaru 7]

I believe that the companies can change all of those options during the open enrollment period each year.