employer NOT insurance co opted out to cover bariatric surgery

 Has this happened to anyone? I just found out how to appeal with the employer. Does this mean I may still have a chance? I really need my insurance to pay! I'm so nervous.

No you don't. If bariatrics is excluded........it's EXCLUDED! Lots of employers choose to exclude WLS from their ins. plans.

Employers decide what benefits they will pay, not the insurance company.  It's just like going to a restaurant and ordering off the menu, a la cart.

So, if your employer has not purchased a WLS rider, it is not a covered benefit.

It depends. If your employer pays a premium to an insurance company, you are screwed. They haven't paid for this coverage so you don't get it.

But, if your company is what they call "self-insured" you aren't screwed. Self-insured means your company pays all the costs for the medical care and the insurance company just processes the paperwork and keeps track of the money. In this case, you can appeal to the company and see if you can get them to make an exception for you.

My employer also has a complete exclusion for WLS - I believe it's fairly common. It meant I had to pay for it 100% myself, but it meant I didn't have to do a 6 or 12 month process to get insurance approval, no nail-biting wait for the insurance company to approve or deny, no having to fight for the surgery option that felt best to me.

Good luck...

If you decide self-pay is an option, you might think about BLIS insurance - it helps cover unexpected "related" medical expenses (like complications post-op). That gave me a sense of control over costs that was REALLY important to me as a cash patient.

 MacMadame is completely correct. I have a friend in the exact same boat and she got it covered. It took sometime, but, it was eventually covered.

If you care to PM me, I can put you in touch with some insurance gurus.

Ms Batt, why don't you share your information with us all.  You know so much about everything!  

Glad to, Medley! Just click on the link in my signature.

http://www.obesityaction.org/advocacytools/insurance/oacinsu ranceindex.php
http://www.obesityaction.org/advocacytools/insurance/appeali ngadeniedclaim.php

try these web sites for some appeal letters and information.