Question:
Insurance coverage for WLS when contract has exclusion for procedure.

I would like to know if it is possible to obtain insurance coverage for WLS even if my contract specifies no coverage for weight losss surgery. Is there a way to get around that? Has anyone used Empire Blue Choice Blue Shield Blue Choice HMO and gotten approval?    — Susan M. (posted on May 21, 1999)

May 20, 1999
I have bc/bs blue choice of CA. don't have empire and don't know what that is but......i was approved within a week or so from the date they recieved the letter. My exclusion read that they didn't pay for bariatric weight loss surgery except with prior approval from the insurance company. they were extremely nice and worked quickly for me. Good luck to you! My surgery is in 10 days!
   — BARBARA R.

May 21, 1999
Susan, my hmo is Community Blue which is a part of Blue Cross & Blue Shield here in western New York. Often your contract will have fine print regarding the medical necessity of the procedure. You can always call them and ask them a theorical question given your weight and medical history. That's what I did and they were able to tell me "it was likely I would be approved". In fact, they approved me and I had my RnY 4/23. Best of luck & God bless.
   — Lisa B.

May 21, 1999
My HMO had a specific clause saying weight loss surgery was not covered. I am a diabetic and my doctor wrote a letter of medical necessity and it was immediately approved.
   — Linda L.

May 21, 1999
Your surgeon will know how to get around that. Mine did. Best of luck to you.
   — Peggy W.

May 23, 1999
Even with the exclusion you should appeal. Use Walter Lindstrom who specializes in getting approval after denial for WLS. He is very good.Most exclusion can be made to pay if you are willing to fight them. Good Luck!
   — Donna D.

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