Question:
What is a rider??????and how do I get one????

I was told by the Docs. office that I needed to get the employer to write a letter saying to ok and bypass exclusion. what does this mean? and is this a rider. I am getting ready for a seminar and want to have my ducks in a row. any help appreciated. thanks sherri    — Sherri H. (posted on April 11, 2002)

April 11, 2002
I think this is something that your employer will have to get from the insurance company. I am not sure but I think that is what it means. I would ask your HR department to look into it and see if they can help you obtain what you need. Just because you need one does not mean that they will give you one though. I think this means that the company will assume the extra charges that the insurance company may charge to cover this type of proceedure. Good luck and you might try contacting your insurance company too!
   — Tawny F.

April 11, 2002
Hi there. Have you gotten pre-approval/pre-certification for the surgery? If not that is a route you need to explore. If there is a known exclusion for WLS then you need to find the wording of that exclusion so you will know what you need waived. If it is an exclusion of anything obesity related then you may have to spell out morbid obesity, if morbid obesity related you then have a barrier. Talk to HR of your company (your benefits person) and have them give you the wording. I was denied 2x because of exclusion but it was reversed. I wrote a detailed letter to my husb. employer of why this surgery was critical for me and had life urgencies. They were self-funded and an ERISA company meaning they fell under federal guidelines in deciding what they wish to and wish not to cover. 3 days later they reversed the exclusion. A rider is entirely different in which you have a policy that has a specific addendum covering specific things. I was lucky in that my surgeons office handled 9/10 of the paperwork, I just wrote letters to go with it and did all of the verbal legwork and pushing. Good luck to you.
   — AJC750