Anthem issues

I checked my Anthem BCBS insurance.  They have an exclusion on my policy: For bariatric surgery, regardless of the purpose it is proposed or performed. This includes but is not limited to Roux-en-Y (RNY), Laparoscopic gastric bypass surgery or other gastric bypass surgery (surgical procedures that reduce stomach capacity and divert partially digested food from the duodenum to the jejunum, the section of the small intestine extending from the duodenum), or Gastroplasty, (surgical procedures that decrease the size of the stomach), or gastric banding procedures. Complications that result in an Inpatient stay or an extended Inpatient stay for the bariatric surgery are not covered. How can I get around this and get them to pay for my RNY? Thanks, L

Unfortunately, it's hard to face a written exclusion policy but it's not Anthem that you are having issues with.  Anthem covers gastric bypass surgery.  Your current employer has "opted" not to have weight loss surgery as an elected benefit.  You should talk to your Human Resources Department about this.  See, if they are going to eventually change this part of the policy.  If they don't elect weight loss surgery as a covered benefit then you are going to either be a self pay or you may have to find another job.   Don't let this be a road block for you.  I had the same problem.  I loved my job but they had corporate offices who didn't see the importance of meeting "my" needs with electing weight loss surgery as a covered benefit, so I found a new job.  I am at my new job and it covers weight loss surgery but I have to jump through some hoops.   I wish you the best of luck. leslie

Hi, I had a similar problem when my employer changed carriers with the start of 2007.  They were planning on offering only the Anthem product which excluded WLS.  I was able to convince them to make the Anthem product available that did not exclude WLS.  This is more expensive to me, but the long term benefit is worth while. It looks like you have two choices, (1) lobby your employer to make the insurance plan which covers WLS available to you, this likely means you (or your employer) have to pay a higher premium, but that is the cost of avoiding the exclusion and getting the benefit you need, or (2) looking for a new job which has a benefits plan which doesn't exclude the procedure.  Apolicy which is written to expressly exclude a treatmetn is very difficult to overcome. Good luck.