Insurance Employer Length Reqs

[Sarah0053 0]

Hey there! First time poster, so appreciate any insight. I’m wondering if anyone has had luck getting an exception from their insurance when their employer requires 36 months of employment. I’m at two years currently, but am anxious to get vsg sooner rather than later. Has anyone tried getting an exception? What did that look like for you and were you approved? My health advocate with BCBS TX said to have my provider submit with the pre-Auth why it is medically necessary to have the surgery now. I have a bmi over 50 and sleep apnea. I hope that is enough to get the pre-auth. I’ve also already done a lot of the surgery approval work, like diet and medication, EGD, etc. Any, appreciate hearing if you had this requirement and got an exception or not. Thanks!

[catwoman7 10,496]

I don't know of anyone right off hand, but what you could do with that time is do your six-month supervised diet, if your insurance requires it (many do - but not all). I had to switch insurance companies to get WLS coverage. I decided in June of 2014 that I wanted to get surgery, but my new insurance wouldn't kick in until Jan 2015. So I asked if they would accept my six-month supervised diet requirement if it was done under my old insurance company. Turned out yes, I could - so that's what I did. So I already had that out of the way when I entered the bariatric program in Jan 2015.

[LookingForward22 319]

For weight-loss surgery no… but other things yes. I have been able to get exceptions approved by the employer for a surgery and medications that would have otherwise not been covered but they were deemed medically necessary.

Your doctors documentation on being medically necessary is the key. Being that there is a time of employment requirement they might stick to that harder than if it was just a matter of policy exclusion or proof of time under a doctors care.

The worse they can do is say no. If your doctors are advocating for this to be sooner rather than later and they have strong medical (life sustaining) reasons why waiting would be detrimental, it is possibly a chance worth taking.

[Sarah0053 0]

Thank you, I appreciate the insight. And definitely, worst they can say is no and I have to wait until next November.

[ShoppGirl 3,226]

Catwoman has a good idea. If your insurance requires a six month medically managed weight loss you can do that in the mean time. You will likely have to do it even if they do approve you to get it earlier.