[caslat]

I am seeking advice on behalf of a friend.

She is considering gastric bypass surgery, but she is facing problems with her insurance.

Prior to her initial appointment with the surgeon, one of the hospital's reps supposedly confirmed with her insurance company (BCBS Florida) that the surgery was covered.

After her appointment with the surgeon, she found out that the surgery is listed as an exclusion in her contract; additionally, her agent said that the company does not offer *any* plans that cover gastric bypass. Furthermore, the agent said that as of recently, there are *no* insurance companies in Florida that offer coverage for the procedure.

Can this be true? Do all WLS patients in Florida pay out-of-pocket? That seems unlikely, but we are not sure what the next step is. Can anyone provide any insight on this??

An individual policy is out of the question due to pre-existing conditions. However, she is currently covered under the group plan used by her parents' company, so there is the option of her family's company switching plans or insurance companies, if we could find one that provides coverage.

Any ideas would be greatly appreciated!

[MsVickie]

Ok what that rep told you about FL not having any insurance policys covering this surgery is ver UNTRUE. Its the plan shes under right now that is the hold up. They dont have a rider on the policy that covers it. Since you said none of the insurance plans the employer has covers it I would go for the parents policy and call them and ask that company if it has the benefits to cover WLS. They could tell you right away. What I will say if it does....... it needs to be the primary insurance. If its a secondary it wont pay if the first one dont. I know that is odd but that is how they work.

Im taking it the company insurance she has is probally through a small company. In the end its what they can afford so you cant really blame them but I feel it should be offered to the individuals as a rider to pay for themselfs. Until the US can get that worked out there will be so many denied benefits which to me is life threating.

So inquire more about the parents insurance and find out what they will pay for. It only takes a call to check on it. If they say yes she has the benefit then ask what there critera is to meet and you can roll from there.

[decker1976]

I agree with MsVickie. Switching to the parent's plan may be an option.