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Clarification needed



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Hi all! I've been a lurker for awhile and have been browsing this forum. I meet the criteria for lap band, but my company has an exclusion for WLS under BCBS in Georgia. I've seen several people who have won appeals, and I need to know whether you can appeal an exclusion or if the appeal was just because the insurance companies covered WLS but didn't want to approve it right away for whatever reason. I'm a little confused on the formalities. I really can't afford to pay out of pocket, but I think there may be a chance for my insurance to cover it from what I've read here. I would appreciate any help so much!

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Exclusion in 99% (or more)of the time means the end of the road for insurance paying you can do what I did and shop for a doctor for self-pay.

My company has an exclusion but we did get them to cover pre-op tests.(they did not cover them for my surgery but my reflux)

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Sorry to hear about your policy :thumbs_up: I have worked in the insurance field for a long time (BC being one of them) and when you have an exclusion on your policy, there is no way getting around it. Applealing does no good. Once it is written into your policy, that's that sadly. Your best bet is to go to your employeer benefit person (you know, the one that no one really knows but writes up the policies) and ask them if they are going to consider covering it in the future. It will probably be futile, but what do you have to loose right? I ended up changing jobs to get mine covered lol.

Sorry to be the bearer of bad news, but I didn't want you to have to go thru a bunch of hoops to only be crushed at the end of a long drawn out battle.

Good luck!

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Sida - Sorry about the insurance. I also have BCBS of GA and they're correct. No way. The only way they will pay is if the company you work for paid extra for a waiver to cover weight loss surgery and so far, I haven't heard of any company that has done that.

What part of GA are you from? I'm down south in Douglas and was banded in Albany by Dr. Bagnato, self-pay of course. I had part of the money on hand and borrowed some from a relative. Can you do it self-pay? It is so worth it. I don't regret it for a moment.

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Thanks everyone for the helpful info. I'm in the Metro Atlanta area. Still deciding on who to go with, still doing lots of research. I will end up probably paying half cash and financing the rest somehow. I just got out of debt, I really don't want to do that again. But, it'd be worth it.

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      IMARC Group’s report titled “Alternative Sweeteners Market Report by Product Type (High Fructose Syrup, High-Intensity Sweeteners, Low-Intensity Sweeteners), Source (Natural, Synthetic), Application (Food, Beverages, and Others), and Region 2024-2032”. The global alternative sweeteners market size reached US$ 4.9 Billion in 2023. Looking forward, IMARC Group expects the market to reach US$ 7.0 Billion by 2032, exhibiting a growth rate (CAGR) of 4.05% during 2024-2032.
      Grab a sample PDF of this report: https://www.imarcgroup.com/alternative-sweeteners-market/requestsample
      Factors Affecting the Growth of the Alternative Sweeteners Industry:
      Health Consciousness: The increasing awareness among individuals about the health issues linked to high sugar consumption, such as obesity, diabetes, and cardiovascular diseases, is supporting the market growth. Consumers are becoming more health-conscious and seeking products that can provide sweetness without the negative health effects associated with sugar. This shift in consumer preferences is leading to a greater demand for low-calorie and natural sweeteners like stevia, monk fruit, and erythritol. These sweeteners offer the added benefit of having minimal impact on blood glucose levels, making them suitable for diabetic and health-conscious individuals.
      Technological Advancements: Innovations in the production and formulation of alternative sweeteners are impelling the market growth. Advancements in biotechnology and food science are leading to the development of high-intensity sweeteners with improved taste profiles and functional properties. Innovations in fermentation processes enhance the production efficiency and quality of natural sweeteners like stevia and monk fruit. These technological improvements are making alternative sweeteners more appealing to both manufacturers and consumers. Enhanced stability, solubility, and sweetness intensity allow these sweeteners to be used in a wide range of products, ranging from beverages to baked goods.
      Consumer Trends and Preferences: Evolving consumer trends and preferences are playing a significant role in driving the alternative sweeteners market. The growing demand for clean-label products, which are healthier and free from artificial ingredients, is offering a favorable market outlook. Consumers are increasingly seeking natural and plant-based sweeteners, aligning with broader trends toward plant-based diets and veganism. Besides this, there is an increase in the demand for low-calorie and sugar-free alternatives that support weight management and overall wellness. Food and beverage companies are responding to these trends by innovating and expanding their product lines to include options sweetened with alternative sweeteners, thereby catering to changing tastes and health concerns of modern consumers.
      Alternative Sweeteners Market Report Segmentation:
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      High Fructose Syrup High-Intensity Sweeteners Low-Intensity Sweeteners High-intensity sweeteners represent the largest segment as they require only a fraction of the quantity to achieve the desired sweetness.
      By Source:
      Natural Synthetic On the basis of the source, the market has been bifurcated into natural and synthetic.
      By Application:
      Food Beverages Others Food accounts for the largest market share due to the rising utilization of sweeteners in a wide variety of food products.  
      Regional Insights:
      North America (United States, Canada) Asia Pacific (China, Japan, India, South Korea, Australia, Indonesia, Others) Europe (Germany, France, United Kingdom, Italy, Spain, Russia, Others) Latin America (Brazil, Mexico, Others) Middle East and Africa Asia Pacific region enjoys a leading position in the alternative sweeteners market on account of changing lifestyles of individuals.    
      Global Alternative Sweeteners Market Trends:
      Governing agencies and health organizations of several countries are implementing policies to reduce sugar consumption as they recognize its detrimental health impacts. Various regulatory bodies are approving alternative sweeteners for use, ensuring their safety and efficacy. These approvals provide food and beverage manufacturers with the confidence to incorporate alternative sweeteners into their products. Additionally, initiatives like sugar taxes in several countries are pushing companies to seek healthier alternatives to traditional sugar.   
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      Note: If you need specific information that is not currently within the scope of the report, we will provide it to you as a part of the customization.
      About Us
      IMARC Group is a leading market research company that offers management strategy and market research worldwide. We partner with clients in all sectors and regions to identify their highest-value opportunities, address their most critical challenges, and transform their businesses.
      IMARC Group’s information products include major market, scientific, economic and technological developments for business leaders in pharmaceutical, industrial, and high technology organizations. Market forecasts and industry analysis for biotechnology, advanced materials, pharmaceuticals, food and beverage, travel and tourism, nanotechnology and novel processing methods are at the top of the company’s expertise.
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      IMARC Group
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      1. Alisa_S

        Welcome!

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        I don't know how to update the ticker, but CONGRATULATIONS!!!

    • Alisa_S

      I joined BariatricPal in 2008 & I FINALLY made the descision to have WLS!! I'm so excited & not sure what I need to do to get the ball rolling, but I made an appointment with my PCP for 7/19. It's a start I guess.
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