Question:
Who can we turn to, so we can get a law passed that makes it mandatory to cover this
I just looked at my insurance carrier which is Tyson's BCBS PPO plan and they will not cover anything to do with weight problems - including: expenses for treatment or surgery for obesity, weight reduction or weight control no matter if you have any underlying conditions complicated by excessive body weight. I really feel if people would stand together and send letters to their congressmen - than maybe they would be made to stop blocking any help we need. Anyone have any ideas about how to go about this? Or has this already been done and have you heard anything on this. Thanks! — Corliss S. (posted on July 28, 2005)
July 28, 2005
This matter is with your employer not the insurance company or congress.
Its a matter of each employer taking out the additional coverage for their
employees. BCBS in many cases covers surgery for weight loss but your
policy doesn't because your employer didn't want that specific coverage.
Speak with your Human Resource Department or Upper Management to see if
they will purchase the additional coverage.
— Irislady
July 28, 2005
First, government regulates the insurance industry. As they have with many
other illnesses, state and federal regulations can be used to compel
insurers to treat obesity. Consider how many states have passed laws
requiring insurers to cover infertility treatments, longer hospital stays
after c-sections and a host of other medical matters. Although employers
can request policies that do not exclude bariatric surgery, many insurers
have issued blanket policy denials for these procedures due to cost
factors.
The place to start is by writing to your local state representatives and
letting them know how important this issue is to you. If you email me
([email protected]) I will forward to you the email which I used
(albeit unsuccessfully) which summarized the health benefits of bariatric
surgery and cited the numerous studies which supported its continued use.
Unforutnately, there is prejudice against the obese and there is an
aversion among many insurers to pay for surgery that results in some short
term costs for the insurer before they see the monetary advantages from
the patient's improved health. However, you can make a difference.
— SteveColarossi
July 28, 2005
Maybe they would consider it a treatment for sleep apnea or Diabetes since
the research is pointing in that direction. It is ultimately cheaper to do
this surgery than to pay for Diabetic supplies and a cpap machine for the
rest of your life. I know that there is a surgery for sleep apnea but if
the sleep apnea if too severe they won't do it and tell you to loose
weight.
— Tera P.
July 30, 2005
A law was passed here in Virginia that makes it manditory for companies to
cover WLS. I work for verizon and the insurance that I had was based out
of Maryland so they wouldn't cover it. I changed insurance and I have my
first appt coming up. My insurance is BCBS PPO. I don't know haw the law
came to be but you could check it out.
— lperusse
July 30, 2005
The INS companies are in the business of making money, and their decisions
on what to cover are simply made with a calculator. Check out
www.HMOSETTLEMENTS.com to see the last 2 $40 million dollar-plus payments
they are having to make for racketeering, denying coverage, and hiding
guidelines from doctors for necessary services. Sadly, I've not seen much
improvement lately in their practices, but more class action suits are
coming their way from local medical societies and doctor's organizations.
— DrL
July 30, 2005
I don't know what state you live in, but I live in NY and have BC/BS PPO
and got approved right away. Don't give up. Did you go through their
appeals process? Surely they must realize that they will be saving money on
you in the long run, as when your weight drops, so will your nedd for
traemtn for other thing, like high blood pressur meds, diabetes treatment,
etc. Every insurance co has an appeals process. There are also governing
boards that monitor insurance co's in each state. Have you submitted all
data to the insurance co, from your MD, stating that this is necessary for
your health?? Don't give up. Call your local congressman for help if you
need it. Does your company offer a different insurance plan that WILL cover
this? Maybe you could switch. Be a pest. It's worth fighting for!!!
— Robin S.
July 31, 2005
If you have insurance through your employer, then it is the employers
decision to cover and not the insurance company. If you employer decides
to have an exclusion added to the policy to not cover WLS, then there is no
way you will get it approved no matter how medically necessary it is. If
the insurance company states it is excluded, ask for a copy of the
exclusion in the policy. They are required to give you a copy of it. If
there is no exclusion, you should be able to get it covered. If they deny
for medical necessity, ask them for a copy of their guidelines on how to
prove medical necessity. GOOD LUCK TO YOU!
— Pamela S.
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