GARY V - Please Help

My sister in law works for Walmart. She has BC of AL.  They refuse to pay for gastric bypass. Period. Absolutely not covered.  Is there any one who has gotten them to pay? Next, my brother has a new job. They are signing up for BC of Tennessee PPO.  I took a skim through their handbook and there are 2 issues we are wondering about.... 1.  Pre-existing not covered for 12 mos.  Is her obesity considered pre existing?  Can she use her certificate of creditable coverage to get this waived, as she has not had one single treatment for obesity in the past 6 mos (or 6 yrs).  She has had hip and joint degeneration for years, since a child, and it is starting to bother her.  She needs treatment and weight loss to stop the degeneration affects on her body.  Is any of this pre existing since she hasnt had treatment for it since childhood? 2.  The language in her policy states: Attachment B - Exclusions of Coverage "Services or supplies related to obbesity; including surgical or other treatment of morbid obesity."  Is there any way around this clause?  Or is it a set in stone sort of thing?  

Walmart is self funded.  We did get them to cover a case in Florida, but it was a long fight.  Potentially you could use that against them for covering it in one state and not another, unless they changed nationwide recently and exclude it in every state. If there is a gap in coverage then there is a pre-existing limit.  Again, you have an argueable point that she did not visit a surgeon, but they're going to argue that her obesity is pre-existing.   The exclusion in this situation, in your state, and with your company is pretty set in stone.  In both cases you should speak with your employer about making some positive changes.

if you have a ccc (certificate of creditable coverage) with no gaps then you do not have to worry about px.