HELP! They want to deny me FMLA saying WLS "Is just a cosmetic Procedure."

Hmmmm ...  Since when does insurance cover cosmetic surgery? Insist on the FMLA coverage. If you have the slightest conplication you'll be out longer and may get fired. That's what happened to me. Don't take anything for granted, not your return to work date, not your boss's good will. Insist.

Although I am not in HR, I have just recently been through some intense FMLA training.  The training was provided by an employment attorney here in Indiana.  She states that to get FMLA you must have a serious health condition.  A serious health condition is  1) in-patient care  2) Incapacity for more than 3 consecutive calendar days (including weekends) AND *Treatment 2 or more tmes by a health care provider OR * Treatment one time with a regimen of continuing treatment such as perscription medicine. I had just been to the plastic surgeon about a tummy tuck and breast lift.  Without knowing I was wondering about this the lawyer said - "even a breast augmentation" should be covered by FMLA - there will be treatment 2 or more times by a health care provider...... So, your company saying it is like plastic surgery doesn't hold water - even plastic surgery can be covered....  At least here in Indiana and FMLA is a federal program. Hope that helps! Lisa

I work in HR and your HR person is badly misinformed about FMLA. I was approved for 3 weeks off for my lapband (only wanted 2). Please go to www.dol.gov. An employer cannot tell you what qualifies for FMLA. It doesn't matter if it's cosmetic or elective. You will be incapacitated due to surgery.   Sharee 

Everyone is right, your HR people are incorrect. I needed to actually contact an employment attorney because my employer kept trying to deny my FMLA for other reasons.  His advice on FMLA forms?  Keep it as vague as possible.  Many people don't even bother to say that they're gone for WLS.  Abdominal surgery would suffice if necessary but just for recovery from surgery should even fit the bill.  Yes, I've done some HR stuff, too, in other jobs. Keep your chin up.  And be vague! Lori

I has open rny and was out a few days shy of 3 weeks.  I used my sick days up and then short term disability since I was having covered surgery.  I didn't ask for anything else and the short term disability made it so I didn't have to use up all my vacation for my surgery.  This year I saved all my vacation for recovery from my plastics and that got moved to next year.. Hugs Heidi

Find the recent article from the Journal of the American Medical Association (someone on OH will have a copy) stating wls is the specific, success treatment in morbid obesity.  You can support your claim of medical necessity.

Jeeze...if someone has a huge growth that is cutting off the blood circulation to some part of their body and a surgeon fixes it, is it considered cosmetic?  No!  But will they look better afterward?  Probably.  The government (IRS) used to claim that (RK...the predecessor to LASIK) and LASIK surgery were cosmetic because, I guess, they thought glasses were ugly.  But the surgery is performed to make the eyes work better.  Maybe, if glasses turn you on, people who have LASIK are actually NOT as good looking. Your surgery is not cosmetic.  It is a TREATMENT for the diagnosed disease of MORBID (meaning it can kill you) OBESITY.  Medicare, for example, doesn't pay for cosmetic surgery...but it pays for bariatric surgery.  Medicaid, for poor people, does not pay for cosmetic surgery. ..but it pays for bariatric surgery.  Bariatric surgery is NOT cosmetic surgery. Whether or not you actually look better after the surgery is of no concern to the surgeon or the insurance company, nor should it be to the employer.  Your surgeon is performing a medically necessary surgery, your insurance is paying for a surgery designed to keep you from dying.  The fact that you MIGHT happen to look better because you're not dying anymore does not give anyone the right to call it "cosmetic."  How ignorant some people are. Sue

They told me the same thing.  I told them insurance had already pre approved me for MO.  Then they said fax it in and paid fine.  Try this and good luck!

IF the IRS considers WLS deductible ----then it is NOT cosmetic...
It is medically necessary to treat the co-morbidities that go along with being obese... like hypertension, diabetes, etc....

I used FMLA with my surgery and the things you mentioned in your email are EXACTLY why I didn't tell anyone at work what kind of surgery I was having!!!  It is not HR's job to determine if whatever you are having done is medically necessary. That is up to your doctor/surgeon.  They are the ones who sign the paperwork and are qualified to determine if something is MEDICALLY NECESSARY!  This kind of stuff makes my blood boil.   Using FMLA isn't a substitute for sick leave or vacation.  It is there to ensure that you will get your job back when you return.  It's saying that they can't "let you go" because of your absence.  It is none of HR"s business what kind of surgery you are having.  You might want to remind them that it is up to your doctor to determine your health needs.  They are  there to administer those benefits. ok - I feel better now!  Good luck with that!