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BCBS but employer opted out

23Stacy

By 23Stacy, in Insurance & Financing

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23Stacy    0

23Stacy
Posted

My BCBS is through the hospital I work for. The hospital has opted not to pay for bariatric surgery. My question is, who do I appeal to? If I have my doctors send letters, what department or job title do they send it to? The insurance company won't help because they say it is my employers choice. Any suggestions appreciated.

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GradyCat    3,697

GradyCat
Posted

I don't think there's an appeal level there for you if your employer opted out of that specific coverage under your plan

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Briswife15    890

Briswife15
Posted

I agree with Gradycat. It is not like they cover it but denied you. Then you could appeal. If your employer just choses chooses not to to purchase that coverage you are kind of stuck. So sorry! Maybe ask HR if they would consider adding it next time they purchase their coverage. If enough folks ask maybe they will cover it.

Sent from my SM-N960U using BariatricPal mobile app

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Sosewsue61    3,185

Sosewsue61
Posted (edited)

What state are you in? Depending on income levels you might qualify for assistance through a different route? Could you sign up for ACA and opt out of employer insurance for one year or get a rider added to BCBS on your own and wait the required time before allowed surgery?

And it's insane that a hospital opted out of bariatric coverage.

Edited by Sosewsue61
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23Stacy    0

23Stacy
Posted

Thanks all! That's what I figured. I am planning to self-pay but my husband wants me to try to appeal first. But as one said, I can't really appeal as it wasn't a specific denial.

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Briswife15    890

Briswife15
Posted

I'm glad to hear you will self pay and not let this stop you!! Good luck with your journey!

Sent from my SM-N960U using BariatricPal mobile app

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ItsABearDance    21

ItsABearDance
Posted

I don't think you could appeal since they simply aren't covering the procedure. You may be able to reach out to whoever handles benefits and let them know how this effects you so they could consider opting in in the future for the benefit of your coworkers, though?

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23Stacy    0

23Stacy
Posted

I am actually considering this as I have a coworker who needs it and cannot afford it. I think it's a travesty it isn't covered.

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Go To Topic Listing Insurance & Financing

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    • Alisa_S

      Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 0 replies
      1. This update has no replies.
    • Alisa_S

      Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 1 reply
      1. summerseeker

        summerseeker

        Life as a big person had limited my life to what I knew I could manage to do each day. That was eat. I hadn't anything else to look forward to. So my eating choices were the best I could dream up. I planned the cooking in managable lots in my head and filled my day with and around it.

        Now I have a whole new big, bigger, biggest, best days ever. I am out there with those skinny people doing stuff i could never have dreamt of. Food is now an after thought. It doesn't consume my day. I still enjoy the good home cooked food but I eat smaller portions. I leave food on my plate when I am full. I can no longer hear my mother's voice saying eat it all up, ther are starving children in Africa who would want that!

        I still cook for family feasts, I love cooking. I still do holidays but I have changed from the All inclusive drinking and eating everything everyday kind to Self catering accommodation. This gives me the choice of cooking or eating out as I choose. I rarely drink anymore as I usually travel alone now and I feel I need to keep aware of my surroundings.

        I don't know at what point my life expanded, was it when I lost 100 pounds? Was it when I left my walking stick at home ? Was it when I said yes to an outing instead of finding an excuse to stay home ? i look back at my last five years and wonder how loosing weight has made such a difference. Be ready to amaze yourself.

        BTW, the liquid diet sucks, one more day and you are over the worst. You can do it.

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