Insurance question........

rkilbury · 12-05-2007, 04:59 PM

If your insurance contract states it does not cover the surgery, is there any chance getting it approved? I have just started the process with my GP so I have no idea what is ahead of me. I just know that there is no way that I can pay for this out of pocket. I already have doctor bills up the ying-yang because I have a special needs son. Is there any hope?

Thanks,
Rondi

AppleSmith1226 · 12-05-2007, 06:55 PM

WHich insurance do you have ???What's GP ??

harmony8411 · 12-05-2007, 07:26 PM

Did you specifically ask if your employer have an isurance rider for weight loss surgery? Sometimes the policy states that weightloss procedures are not insured, but your employer will purchase a rider to cover the cost anyway. My policy states that no weightloss interventions are covered. When I called the health insurance rep she said I was'nt covered. When I called another time I was informed of the rider. Soemtimes it is all in how you word the question and who is helping you on the other line. Hope this helps.

rkilbury · 12-06-2007, 02:43 PM

I live in the Seattle area and have the Group Health Cooperative, Options plan. GP (my regular doctor) I know I'm gonna need a referal from her to get to the surgeons.

**Wheetsin** · 12-06-2007, 03:55 PM

Find out if the exclusion is plan-enforced or employer-enforced. What usually happens (unless you're employer is very large) is that insurance companies lump together their most frequently selected options. From there, your employer can ammend the contract (via a rider, as a previous poster mentioned), they can take it as is, or they can exclude portions of the package to save cost.

If your employer's contract excludes it, it may be something your employer has opted to include. If it was included, and your employer opted to exclude it, there's not a whole lot of wiggle room. That would be like buying a car that didn't come with a warranty, and then trying to get warranty work done.

I would suggest a careful review of your SPD to see exactly what is says, and a call to your HR admin/rep.

rkilbury · 12-06-2007, 05:13 PM

From what customer serive said to me it looks like the employer opted out of anything to do with weight loss option. But I did have them send a copy of the contract to me siI can go over it.