Interesting...very interesting!

How many of us had had to fight with our employers and the insurance companies they provide for us to get this surgery?  Well, here in a National Human Resources magazine (that I get via email every week) is an article...take this and show it to your HR/benefits person...they might start changing their tune about it!

http://www.workforce.com/section/00/article/25/80/22.php

As I said...interesting...very interesting....

Interesting. I'm not very familiar with benefits, but I would never known that employers wouldn't want someone to undergo WLS. Do employers have negative feelings about it because it drives up the cost of insurance? I work for a company with about 600 employees in the US. Would companies of this size not have as much of an issue as a smaller company? If insurance approves me, can my employer say no or something? I'm all confused.

Kristy - if you are approved, you're approved. Your employer cannot after your healthcare insurance has approved your for surgery, deny you. At least not that I'm aware of. And I'm guessing there are some lawyers out there who'd be all over that if it happened.

What can happen though, is that the employer excludes weight loss surgery from their healthcare policy(ies) offered to employees. Obviously, bariatric surgery is a big cost medically and depending on how long you're out of work, can cost the employer that way as well.

I didn't know employers could exclude it to be honest, but my DH works for Qwest and it happened to me last year when I submitted for approval. A company the size of Qwest was not worth it for me to go up against, so I opted to go on my employer's plan during Open Enrollment.

If you know of others at your work that have had bariatric surgery and they are on the same plan you are, likely there is no issue.

Thanks for the reply. When I first met with Fairview WLS I had to call my insurance, ask specific questions to see what was covered, etc. I guess I would have found out at that first call if it wasn't. If I recall it's covered at 80% since Fairview is a provider or part of BCBS program/in network - I forget what they call it.

I was going to reply, but Amy beat me to it...of course, I was suddenly swamped here at work with stuff to prepare for our Open Enrollment coming up. 

Many larger companies cover their employees under a "self-funded" plan.  What that means, is that they utilize the insurance companies such as Blue Cross/Blue Shield, HealthPartners, etc. so the employees can take advantage of the discounts they have worked out with the doctors/clinics/hospitals, etc. Then, the insurance company approves or doesn't approve based on the plan (or contract) that they have with your company and then pays the claim.  They then turn around and bill your company for the amount that they paid, plus a "handling fee" (for lack of a better term).  Because of this agreement, your company essentially states what they will or will not cover.  They don't use a 'pre-packaged' plan from the insurance company, they create their own based on the claim history of their employees and the budget they are under.

and FYI...Fairview is a network provider for BCBS and you are responsible for the co-insurance (the 20% after the deductible has been met, and before you meet your annual out-of-pocket maximum)

Can you tell I work in HR/Benefits? YIKES!

I love reading articles like that - you would THINK that insurance companies would understand the economic benefit of approving surgery! 

The lady at the end of the article was on 4 meds pre-op, down to none post-op.  I was on 8 pre-op!  Now?  Once in a while, if I'm naughty, I'll give myself a few units of lantus (long-lasting insulin) at night.  I used to give myself 92 units EVERY night!  Plus @ 60 units of Humalog, which I'm completely off.  And 1000mg of Metformin, which I'm off.  Plus bp and cholesterol meds, all of which I'm completely off.   The only thing I still take is Synthroid, which I could very well be on forever. 

I'll take that vs. having my very own pharmacy at home ANY FRICKIN' DAY!!! 

Laurie,

This is a very frustrating topic for me as I fought with my company for 4 years to get them to allow the surgery under our plan, to no avail; I had my surgery self-pay in Mexico (God bless a good friend of mine). However, I did forward this article to our HR VP - I think it's a great article for her to read!

Thanks for sharing!
Tracy