Great new job with lousy health BCBS of AL insurance policy - no bariatric surgery coverage?

[SkinnyKathy 99]

I had a lap band under United Healthcare PPO in 2008, lost 250 pounds, then had to have it removed in 2018 due to terrible acid reflux, Kaiser insurance. Have gained over 100 pounds back. Now I want to have RNY gastric bypass, and was set to get this going through Kaiser but got derailed due to COVID. Now I just started a great new job which I am very excited about, but the downside is that they only offer one insurance option, Blue Cross Blue Shield of Alabama. I have to start the whole insurance process all over again, in fact find new doctors again, but today I called the customer service number for BCBS of AL and asked about bariatric surgery and they told me that it is not covered on my policy!

Has anyone ever had this experience, and were you able to find a way to get bariatric surgery covered under appeal? I really want this surgery but the out of pocket costs are pretty bad. I can't believe that this isn't covered in any form. Help!

[catwoman7 10,878]

not all policies cover it. I had to change insurance companies to get it (fortunately, my employer had several options), but I had to go with the most expensive policy they offered. I stayed on it for two years, I think (in case there were issues...), and then switched back to my original policy. Five years later, of course. all of their policies covered it...oh well...

anyway, it's not an issue with BCBS. It's an issue with your employer. Most insurance companies actually DO have a bariatric surgery rider, but employers can pick and choose which things they want to include in the particular policies they offer to their employees. I was told by our HR dept that it was pretty expensive to include bariatric surgery coverage, so they only covered it in their most expensive (to the employee, that is...) policy.

[SkinnyKathy 99]

Ugh. I see I will have to lobby the head of HR to include more insurance options next year. I don't mind paying more for better health insurance to get bariatric surgery covered. I just wanted to get it done in 2021, not wait until 2022. I wonder if I should start documenting the 6 months of medically supervised weight loss now in anticipation of hopefully a new medical insurance option in 2022 that will cover it. Or would the six months have to start once the policy is valid?

[Jaye W 218]

I think it would have to start with the new policy

[catwoman7 10,878]

12 minutes ago, SkinnyKathy said:

Ugh. I see I will have to lobby the head of HR to include more insurance options next year. I don't mind paying more for better health insurance to get bariatric surgery covered. I just wanted to get it done in 2021, not wait until 2022. I wonder if I should start documenting the 6 months of medically supervised weight loss now in anticipation of hopefully a new medical insurance option in 2022 that will cover it. Or would the six months have to start once the policy is valid?

in my case, my new insurance policy (which DID cover bariatric surgery) accepted the six-month supervised diet that I did under my former policy.

[lizonaplane 1,605]

You can also consider going to Mexico to have it done for about $5000. It's not something I would do, but many many people do it. Medical Tourism is a huge industry. Or you can self-pay in the US, if that's something you can afford. Just find out from your insurance company if you would have to pay for any follow up if there were complications. Like if you developed a leak in the staple line and needed another surgery, would you have to pay for that, or would insurance cover it.