insurance problems

i have a friend that has blue cross blue shield Iowa based, his company that he works for is in rockford illinois and he said the insurance has a claus by his company dening bariatric surgery. can't he fight this? he is very over weight, has high blood pressure and other problems due to obesity, can any body help with some info? or can he go to to a bariatric center and let them worry about this? i would think this is what appeals are used for even though it's the company he works for thats putting the claus in and not the insurance company, unless the insurance company complies with the companies' claus

It is the employer that chooses what coverage they are going to include in their policy. There is very little from what I understand that he will be able to do even if it is medical necessity for him to have bariatric surgery. I know it stinks, but an additional rider to cover this surgery is expensive. Maybe there is a possibility of taking out a medical loan, second mortgage or a loan from his family to self pay. There might even be a few doctors out there that will swing a payment plan. Good luck to your friend. Sorry that I could not offer more hope. Chris

thanks chris i will tell him but you would think there could be a loop hole some where

I do not think that insurance companies allow for any loop holes. They are out there to make money off of clients, not spend it on them. When you take a look at the large insurance companies corporate offices, they are usually decked out to the nines because they are spending all of our money to build and furnish them. Chris

Wish I had better news for your friend. But if the employer's policy exludes bariatric surgery there is really nothing that can be done...other than look for a new job. I wish your friend lots of luck.

thank you again for your comments, it's too bad these restrictions are out there when it will cost the insurance companies more money in the long run due to over weight problems

Tell him to go to his employer's HR department, he might be able to appeal to them to get this included. Never know until you try. Good Luck