There are six states that have to approve bariatric surgery if medically necessary. Unfortunately I don't live in one of them.  Now that my insurance has changed to include preventive measures, I will try again. It seems hypocritical to claim to want to prevent common (expensive to treat) illnesses and then refuse to cover a surgery that will basically eliminate my pre diabetes and drastically reduce if not eliminate my chance of getting a host of other illnesses like heart disease and cancer.  What I have going for me now is that we have partnered up with an outside medical company to administer and monitor our testing and provide 'coaching' to employees. I believe a weight loss program is covered and since I have proof of already doing a medically supervised weight loss program, I can prove I have already tried that. I am hopeful that since this company is separate from my employer, they will have a more far sighted and rational opinion of this and may support me. Or not. I have no idea until I try and I have already started the process by emailing the coach to see if she can direct me. When I first had to go for the initial blood work required by this new policy, I asked the nurses how I could get approved and they mentioned something about proving medical necessity. I can do that. However I know I can't rely on what they said as confirmation of coverage. Fingers crossed...

Has anyone had any luck getting approved through a company that is self funded? I currently work for a local public school system in Florida and we are a self funded organization. Recently the board has changed our insurance to something called Pathways, which is more or less a behavior modification system in my opinion (still self funded.) There are three levels of insurance employees can get based on how compliant they are about following a strict regiment of testing. It is supposed to be a more preventative type of health insurance as everyone who wants decent coverage must get certain tests at certain ages. If an employee does not want to get a colonoscopy every five years, for example,  then they will not get the decent coverage they need. They will be dropped to a bare bones policy. I understand the logic of this type of plan but I just don't believe this is necessarily going to work. Bariatric surgery is not covered and to me this voids the whole prevention concept behind this type of insurance plan. My question is this: has anyone ever managed to get approved for bariatric surgery while working for an organization that was self funded and/or offered the same kind of tiered insurance plan? I had to undergo some lab work just to get the second level of insurance so I have documented proof already of certain conditions and my doctor can provide even more proof. There is definitely a medical need in my case and proof to back it up but in Florida, I don't believe there is any law that will force my employer to pay for the surgery even though there is a medical necessity. If anyone has had any experience or can offer any advice, I am listening. Thank you.

I'm glad you finally got yours overturned, that's so crazy. That's sort of what was happening to me.... the paperwork had been sent 5 times, but she still didn't have it. I ended up calling and requesting that my case be assigned to a different nurse, I had to leave a voicemail. The next day I got a call saying I was approved. Now I hope the billing stuff isn't a hassle, I certainly do not have any extra cash. I don't have a date yet, but hopefully today. Good luck to you!

Hi  Kelli,

I don' have Aetna through UPS, but I do have Aetna.  I had my surgery in 2009 and all three of my kids had surgery in 2010!! (my two boys had surgery 2 weeks ago tomorrow!)  We were all approved through Aetna.  Two of us denied at first and appealed and got the denial overturned.  The two boys, both were approved at first submission.  We submitted their paperwork and were both approved within two weeks.

Nan

Again thank you for your input unfortunatley I have to go with what my insurance covers.  The MTF on base dosen't do major surgeries and would refer me to the center I am going to anyways so RNY is what TRICARE covers and that is what I have to go with.  I have done a lot of research and I feel this is what is best. Again thank you for your input.

Have a nic day.

Jess