I know it's heartbreaking to be discover that your health insurance does not cover WLS. I know it makes no sense that they will cover complications due to heart disease, diabetes, back and knee problems, etc. I know it can be very costly to pay for all, half or part of the surgery yourself. It's frustrating and it's not fair.

That said, insurance companies don't choose to cover or not cover WLS, your EMPLOYER does. It's truly a bum rap that insurance companies take when people take their anger out on them because they can't get the medical procedures they want. ***IT'S NOT THEIR FAULT***

No, I do NOT work in the insurance industry, nor does anyone in my family. I don't have stock or any other investment in insurance and I don't benefit in any way for sticking up for them. It's simply not true.

BCBS VA covered mine 100%. BCBS VA denied my bestie because her company chose a different package. Our old insurance Aetna would only cover 75% five years ago. When our renewal came up, they covered 90%. For some people they cover 100%, for county and state employees in my area they do not cover it at all.

Companies pick insurance packages based on the cost to them. If they choose not to cover WLS, that's on them. Your insurance company will cover anything the package covers.

If you have an issue with the coverage that you are offered, contact your employer. Fight/petition/beg/plead/pester your human resources and benefits director until they make the change. When you fight the insurance company, you are fighting the wrong party and you are wasting your time.

I am NOT talking about denials, I am talking about no coverage. Please do not get the two confused. Big difference. Find out the reason, fight the reason, but fight the right fight with the right party.

In mine and my husband's case, it was the way the policy covers WLS that was the problem. They have the usual requirements, like a certain BMI for a certain length of time, 6 months medically supervised weight loss, etc., but those weren't the issue. The problem we had was that after you had met all the requirements and been approved, you had to pay the first $5,000 out of pocket before the coverage would kick in, then once it did, it only paid up to a maximum of $13,000. So after we added it up, we would have been out of pocket approximately $18,000 for each of us, which was out of the question. And that was just for the surgeon and hospital, it didn't include the anesthesia or any pre-op testing.

That is also the policy they employer bought. I have a similar insurance now, and I have to pay the first $2600 out of pocket before they ever start to cover anything - and that's for any and all medical coverage they do provide. I don't even think they cover WLS at all. When I had my sleeve, I worked at a different place, and the policy covered almost everything. If I didn't already have surgery, I'd be flying to Mexico for one of those $3900 gastric sleeves Alex is advertising, for sure!

That's definitely untrue in my case. The BCBS provider in my area, Excellus, does cover WLS but with ridiculous restrictions. They require a documented BMI of over 40 for 5 years with no comorbidities or over 35 with comorbidities. I lost 90 pounds "on my own" in 2010/2011, which put my BMI well below 40. I regained and re-lost and regained and re-lost my way back up over the subsequent 3 years, eventually ending up well over a 40 BMI again. However, since I just got back up over 40 in the past year, I would have had to wait another FOUR years to qualify for surgery. I felt like they were punishing me for at least TRYING to lose the weight on my own. Had I just stayed fat back in 2010, I'd have qualified for WLS this year!

Edit: Here's a link to the specific policy on the Surgical Management of Obesity. Item 1B states: "The condition of morbid obesity must be of at least 5 years duration."

https://www.excellusbcbs.com/wps/wcm/connect/7626cc31-589a-449c-8757-09ef8ac1a985/mp+surg_obes+tac+#2+13.pdf?MOD=AJPERES&CACHEID=7626cc31-589a-449c-8757-09ef8ac1a985

That's the package your employer chose.

That's the only BCBS provider in my area. I suppose they could have chosen one of the other insurers instead of BCBS, but I don't even know what else is available around here. BCBS is definitely the only big one. Excellus definitely doesn't offer any better WLS at least. That link on their website is for their general WLS policy, not specific to any plan.

That's definitely untrue in my case. The BCBS provider in my area, Excellus, does cover WLS but with ridiculous restrictions. They require a documented BMI of over 40 for 5 years with no comorbidities or over 35 with comorbidities. I lost 90 pounds "on my own" in 2010/2011, which put my BMI well below 40. I regained and re-lost and regained and re-lost my way back up over the subsequent 3 years, eventually ending up well over a 40 BMI again. However, since I just got back up over 40 in the past year, I would have had to wait another FOUR years to qualify for surgery. I felt like they were punishing me for at least TRYING to lose the weight on my own. Had I just stayed fat back in 2010, I'd have qualified for WLS this year!

Edit: Here's a link to the specific policy on the Surgical Management of Obesity. Item 1B states: "The condition of morbid obesity must be of at least 5 years duration."

https://www.excellusbcbs.com/wps/wcm/connect/7626cc31-589a-449c-8757-09ef8ac1a985/mp+surg_obes+tac+#2+13.pdf?MOD=AJPERES&CACHEID=7626cc31-589a-449c-8757-09ef8ac1a985

That's the package your employer chose.

That's the only BCBS provider in my area. I suppose they could have chosen one of the other insurers instead of BCBS, but I don't even know what else is available around here. BCBS is definitely the only big one. Excellus definitely doesn't offer any better WLS at least. That link on their website is for their general WLS policy, not specific to any plan.

Your employer chose to go with Excellus, a low cost licensee of BCBS. They didn't have to do that. Your employer chooses how much coverage they want to provide you. In turn, you choose to go with that plan or go somewhere else.

You are right...To A Point.

My office does nothing but process claims to insurance companies for pre-determination, pre-approvals, and later reimbursement.

It's what we do...I attend clinics everyday, each day a different Hospital/Facility, meet with patients and their families for evaluations, then submit to their insurance co. to see if they will cover the cost of what was prescribed at the eval.

Bottom line, Insurance companies do not like to part with their money...they are, after all, there to make money.

Not all are bad, there are excellent ones...

But sometimes, the illogical hoops they make you jump through...throw common sense out the window...you're dealing with real idiots!

Sometimes I think it is a tactic, that if they make it difficult enough, you will give up and go away.

And the more the federal government gets involved, the worse it gets.....then Insurance Fraud becomes more prevalent...only adding to more regulations and hoops...