Jump to content
×
Are you looking for the BariatricPal Store? Go now!

How does insurance and employer exclusion work?



Recommended Posts

Forgive me - I know nothing about insurance. I am the idiot in the corner selecting my plan by the "Eeeny-Meeny-Miney-Moe" method. I am not proud, but it is what it is....

I am banded, have been since September, and my friend wants to get the band. She has UHC, and was told her plan doesn't cover it. I have UHC through a different employer and they did cover it.

My question is this: Is there any way she can get supplemental insurance that would cover the band?

Was anyone here told their insurance did not cover the procedure, but then was able to get around that somehow?

Also, if it is employer exclusion (I'm certain it is, since mine covered it, but don't know for a fact) how do go about reversing that? Was anyone sucessful in doing that? If so, how?

Thanks!

Share this post


Link to post
Share on other sites

An employer exclusion is when the employer opts out of certain coverages to reduce the overall cost of providing insurance to its employees. When you're facing an employer exclusion, AFAIK, the only real course of action you have is to ask your employer to add the piece it excluded. Not many employers are willing to take on the extra costs (can be significant) because one person wants something done. So my personal suggestion if you're going to go this route is to work with peers who also have interest, do the math, and show them some ROI numbers. I can't say it will have any success, I've never seen anyone come out with good news, but at least it's a smarter way to approach it than, "because I want it." :thumbup:

Do have her check where the exclusion is. Because your UHC plan covered the lap-band doesn't necessarily mean all UHC plans will. Even within my own work building, carrier covered my band under my plan, but others with the same carrier, different plan, are not covered.

I've only seen one person ever claim success and they worked for a small company and knew the owner and had them pull some strings or something like that. *shrug*

Supp plan for lap-band, I don't know enough to say yes or no, but I would guess not very likely. Especially when you're MO, supp plans are VERY hard and can be VERY expensive to get.

LMK if I can guess at answers to any other questions. :tt2:

Share this post


Link to post
Share on other sites

:thumbup: Thanks! Your guesses probably have more education and truth behind them than what's in my little finger!!!

She does work for a small(ish) company, and knows the firm administrator pretty well....hopefully she can take that route and persuade them to add it.

Question about that: Can a company add that for, say, one year, and then change it again later after the procedure has been done?

Share this post


Link to post
Share on other sites

I believe that the companies can change all of those options during the open enrollment period each year.

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now

  • Trending Products

  • Trending Topics

  • Recent Status Updates

    • LeighaTR

      I am new here today... and only two weeks out from my sleeve surgery on the 23rd. I am amazed I have kept my calories down to 467 today so far... that leaves me almost 750 left for dinner and maybe a snack. This is going to be tough for two weeks... but I have to believe I can do it!
      · 0 replies
      1. This update has no replies.
    • Doughgurl

      Hey everyone. I'm new here so I thought I should introduce myself. I am 53y/o and am scheduled for Gastric Bypass on June 25th, 2025. I'm located in San Antonio, Texas. I will be having my surgery in Tiajuana Mexico. I've wanted this for years, but I always had insurance where bariatric procedures were excluded. Finally I am able to afford to pay out of pocket.  I can't wait to get started, and I hope I'm prepared for the initial period of "hell". I know what I have signed up for, but I'm sure the good to come will out way the temporary period of discomfort and feelings of regret. I'd love to find people to talk to who have been through the same procedure or experience before. So I look forward to meeting you all. Hope you have a great week!
      · 0 replies
      1. This update has no replies.
    • 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. LeighaTR

        I hope your surgery on Wednesday goes well. You will be able to do all sorts of new things as you find your new normal after surgery. I don't know this from experience yet, but I am seeing a lot of positive things from people who have had it done. Best of luck!

    • 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

        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.

    • CaseyP1011

      Officially here for a long time, not just a good time💪
      · 0 replies
      1. This update has no replies.
  • Recent Topics

  • Hot Products

  • Sign Up For
    Our Newsletter

    Follow us for the latest news
    and special product offers!
  • Together, we have lost...
      lbs

    PatchAid Vitamin Patches

    ×