Self pay or change insurance...
Hala. RNY 5/14/2008; Happy At Goal =HAG
"I can eat or do anything I want to - as long as I am willing to deal with the consequences"
"Failure is not falling down, It is not getting up once you fell... So pick yourself up, dust yourself off, and start all over again...."
Were you told this by your insurance company? I'd suggest obtaining a written copy of your policy that shows it as excluded or gives the criteria for WLS.
As the others have said, first get a written copy of the policy so you can see for yourself the exclusion (in case whomever told you it want covered was wrong!). If it IS excluded, there isn't anything you can do except self-pay or change insurance. Unfortunately, if your insurance is through your employer, you are stuck with their options, and if your PPO doesn't cover it, their other policies probably won't either.
If you have an individual plan, you could investigate other policies. Apparently SOME of the plans offered by the new healthcare marketplaces cover it.
10 years out; 190 pounds lost, 165 pound loss maintained
You don't drown by falling in the water. You drown by staying there.
Let me share my experience. I took out my ins. Specifically because it covered WLS. When I started my journey, the coordinator at Mayo told me to call the ins. Co. And ask what specifically covered and she gave me some codes to check. I called the ins. Co. And told the rep what I wanted and she says, "Oh you have no coverage for WLS." I told her I had checked out the website befor I purchased the policy and saw coverage for WLS. She puts me on hold and comes back and tells me "oh, yes, I see it now!" Then started spurting out all the codes on my list that was covered. So don't take no for an answer. Do research on the ins.co. Website and know what your talking sbout before calling. WLS if nit covered will be under Exclusions.
Don't despair, request a policy/benefits booklet, don't go by what someone else tells you at your work-place or by what BCBS customer service tells you on the phone. I too have BCBS of AL & they prefer the term "morbid obesity" coverage instead of weight loss surgery coverage. At first my bmi was in the high 30's like you & even though it was very close to the 40's the first time I tried to get approved with 6-7 months of physician supervised weight loss visits BCBS turned me down. I even had a crazy doc suggest I gain more weight so I could get covered; I did gain more but not on purpose. BCBS also seems to prefer that you have pre-existing health weight related problems; crazy I know as we'd all be healthier if we had our weight under control...
My pre-existing conditions were sleep-apnea,-which the insurance coordinator at my weight loss clinic sent me for testing & counted me as having it even though I was 1.9 percent instead of 2 on their testing scale, low-thyroid/thyroid nodules, high cholesterol & HBP, find a weight loss surgeon then work with the insurance coordinator at the clinic as they will know how to work with whatever insurance you have to get you approved; my coordinator helped me get approved on the second try for VSG which I had on 3/13. Her efforts alone I believe are what finally got me coverage because she knows how to work with getting insurance approvals. Don't give up with trying for insurance approval, surgery is so expensive without it & if you travel you will probably have a great experience but your Doc will be far away so no follow-ups & support which you will need.
Good luck & don't go by what you are told verbally, request the booklet & find a Doctor then explain to him/her that you need to try for insurance coverage due to costs & hopefully they'll work with you like my Docs did. They get paid a lot by insurance companies so will hopefully work with you.
With God ALL things are possible! VSG 3/13/14 Dr. John Mathews