Help! insurance won't pay

I am in the middle of my weight loss journey...however my BCBS does NOT cover WLS....they said it was the plan that my employer chose.....someone suggested I speak to my HR person at work but someone also said my employer could NOT change the plan (even if they wanted to****il the annual year was up...(april 2015)

I just wanted to know if anyone else had this experience....

That really stinks.  I have bcbs and they approved mine.  Keep at it you may have talked to someone that doesn't know what they are talking about.  Keep pestering them.  Ask them to send you a packet of the guide lines for wls.  Don't give up.

If WLS is explicitly excluded by her employer, there won't BE any guidelines to send her!

Lora

Sorry to hear that. Insurance to cover WLS cost much more than plans that do not.  A lot of smaller companies choose the lower cost plan so they and the employees can afford that.  Unfortunately there is not much you can do.  You may ask HR about them choosing a plan next year that will the WLS.. Maybe they will, maybe they will not.  However changes are very slim they will. (From my experience) . 

Your option may be to find a new job with insurance that covers that, or self pay in US or Mexico...

Are you married?  Does your spouse have a job that covers this type of surgery with their health insurance?  If so, it might be worth switching to their insurance during the next open enrollment just to get the surgery covered.  I was in this same boat - luckily my hubby's insurance plan covered it. 

I had the EXACT same issue with BCBS they had no WLS rider. I work for a small company.  I was lucky that my husband had Tricare and it was my secondary.  They did cover it. Everything went through bcbs first and was denied then to tricare for payment! I hope there is an option out there for you.  I considered self pay but my surgeons office really wanted me to avoid it if I could just because of the way any issues that you develope over the course of many years can also be denied since the orginal surgery was not covered.

What Hala said.  There is probably nothing you can do in terms of getting your employer's insurance to pay for it.  Self pay, a new job, or possible coverage under a husband's plan would be more viable options.

Many employers, because they are faced with increasing medical insurance premiums, are excluding WLS again/still (many plans added it over the past few years but now it is decreasing).  Unfortunately, in order to offer that coverage for the very few people who would utilize it, they would have to raise premiums (often very significantly) for everyone (and if they are going to opt for higher premiums, it would be in exchange for coverage of services that more people would use than WLS).

Lora

You got accurate information.  Employers can save a ton in premiums by excluding some benefits, WLS being one of them.  You cannot force BCBS to cover something that your employer specifically excluded.

The only thought I have to add, is the idea if you self pay the insurance won't cover things in the future. I thought with the new Obamacare plan this year all pre exsisting conditions must be covered. So if something came up down the road.... wouldn't it be a pre-exsisting (yes, I had WLS) condition? Not Sure, just a thought.

No, it wouldn't be a pre-existing condition if she chose to self-pay while she was covered by that policy.  

Insurance, however, might still pay for certain types of complications down the road, though, even if they didn't pay for the original surgery. The risk, though, is still there, of course.

Lora