Employer BCBS doesn't cover bariatric surgery

[queenkudela 0]

I'm honestly at a loss for words right now. I started a new job a few months back with the most amazing benefits only to find out that bariatric surgery isn't covered under their plan. What do I do?! I definitely don't have 23k to pay up front for the surgery. Has anybody else had a similar experience and managed to get the surgery anyway?

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[butterfly715 17]

I will see if you can apply for a second insurance to cover Co pays and coinsurance. I believe the Affordable Care Act covers bariatric surgery. You will have to submit to your primary insurance first, once its rejected it will fall onto your secondary. I'm not sure if it will work for sure but I will suggest looking into it.

Simply Me

[ANewMe2017 10]

I have Employer BCBS NY and they cover it.

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[ahousebeck 0]

Double check that there isn't an exception policy. They told me and my doc they didn't cover it. I got my plan book out and read the whole thing (it can be taunting) but found information they had looked over. Best thing to do is give them a call. I had BCBS and live in ohio

[Packertrav 3]

Some states the insurance company's are not allowed to exclude the surgery. Texas allows the exclusions. I had to pay over $14,000

[Treadmillwalker 486]

It can depend on which level of the plan you have. For example my employer's BCBS plan does not cover WLS on the Gold plan which is the plan that costs the most in premium and pays the best benefits. The Silver plan does cover WLS, but there is a $5,000 deductible plus some things are not covered. Check with your company's benefit coordinator.

Lap-banded and love it!

[kkami12 52]

Mine did, i would have drs office resubmit or have them look into it

[Montana Girl 7]

My BCBS plan, offered by the hospital I work for, has a blanket exclusion for all bariatric procedures. I fought the denial, with letters from my doctors and other documentation. Even the CEO of the hospital told me that exceptions could be made. They denied again, in spite of multiple comorbidities. I met all the criteria for needing the surgery. I went ahead and took an emergency withdrawal from my husband's pension. This was maddening, as I have been working and insured for my entire life (I'm 54) and the ONE thing I need to save my life, was denied. With no other options, I had the surgery and paid cash. I'm 3 weeks out now and have no regrets. I do plan to pursue further appeals, but I had to get healthy first. It's quite discriminatory to refuse coverage for bariatric surgery. Could even be illegal. Will contact the ASBMS for further guidance. Don't put it off if you need the surgery.

[SharBear617 146]

I applaud your determination in finding a way to do exactly what you knew was the right decision (and yes, a life-saving one at that), but I'm so sorry you had to take an economic hit for it. You're absolutely right, it's ridiculous and should not be legal to exclude such a scientifically proven intervention for weight loss and the comorbidities that go with it.

Even more maddening that insurance companies will gladly pay for things like Viagra (sorry guys, as much as you think your life depends on it, it really doesn't), but balk at saving lives. Fight a good fight!

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