Question:
I have BC/BS of GA also and bariatric surgery is excluded. Mine is through the

University System of GA. When I called the insurance company in Atlanta they said to blame the employer. Is this correct? She said "no appeals" period.    — ELVIS (posted on February 1, 2006)

February 1, 2006
Unfortunately, many state BCBS plans have an exclusion for Gastric Bypass or any WLS. This is a sad fact that only 30 % of employers in the United States will cover the surgery. Each employer does have the right to exclude the surgery because covering it increases the montly premiums for everyone. I work in the healthcare industry and in HR. SO I have head the arguments over and over. Because Healthcare workers are so expensive to cover anyway- our company pays for the surgery because we can prove after weight loss and recovery- that indivdual costs less to insure overall. That fact allowed me to get RNY last year. I hope you can find another option. You may try talking to your HR-Benefits area and see if indeed there is an exclusion. The benefits Director/Manager should have that information. Very sorry for your struggle. Hope all turns out as you dreamed it would!
   — ppaige

February 1, 2006
I work for Walton County Schools and it was also an exclusion of their insurance. Even with a BMI of 56 and co morbidities I was still denied. All I can say is don't give up. Eventaullay I was approved throgh my husbands insurace. JUST DON'T GIVE UP!!!! you can e-mail me if you would like [email protected]
   — kchurchwell

February 1, 2006
Ann, That was the case for myself and my husband. (We've both had WLS.) We went through every hoop we thought possible - including writing an appeal to the employer, who could choose to opt in or out of the option of including bariatrics on the insurance product they purchase. They basically told us to take a flying leap (even though I had five letters of medical necessity accompanying my letter!). We ended up self-paying for surgery. I had my surgery 3.5 years ago with Dr. Aniceto Baltasar. My husband had his surgery with Dr. Baltasar 1.5 years ago. We both consider the fact that insurance didn't cover a huge blessing because we would have never found Dr. Baltasar otherwise! Dr. Baltasar is great! He is on the standards committee for the ASBS, has been honored by the American College of Surgeons for advancements in the field of bariatrics, he is a past president of the IFSO (international federation of obesity surgeons), and is the founder of SECO (the Spanish obesity surgery society). He is considered to be one of the world's best and leading bariatric surgeons - and, he's just a super sweet guy! Self-paying sounds daunting, I know. But it can be done very affordably (particularly if you choose an out of country option - we paid about $15,000 for my surgery and expenses). The care was top notch, and Dr. Baltasar continues to be a caring, involved member of my health care team. Whatever you do - remember you're worth it! So often we women tend to think we shouldn't take care of ourselves because we're so focused on taking care of others. There comes a time, though, when you've got to take care of yourself or there will be no taking care of anyone! Please let me know if I can offer any help, okay? You'll be in my thoughts and prayers. Blessings, dina
   — Dina McBride

February 1, 2006
when all fails, come to the DS forum and ask about self pay, it is so comon, that we know the doctors, the bank clerks and waiters by name, at 13k all inclusive for the best doctors,hospitals in the world,and the best of the three options, many choose the self pay route for the ds.
   — walter A.

February 10, 2006
They say blame to employer because it is the typical "pass the buck" syndrome. There is always an appeals process. You should definitely request an appeal and if it is a benefit exclusion the ask for an exception to benefits. Send a letter to the president of the insurance company and to the insurance commisioner for your state with all of your medical neccessity information including letters from your physicians. Good luck.
   — catleth

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