Right now my biggest fear is not getting insurance approval for the surgery. Once my surgeon confirms that the insurance will cover the surgery, I’ll be able to breathe a lot easier. When I first started contemplating surgical weight loss two years ago, one of the first things I did is call my health insurance company (Capital BlueCross) and ask if they covered it. They looked up my specific coverage plan (which is provided through my husband’s employer; we pay nearly $500 a month to cover the two of us) and confirmed that yes, surgical weight loss would be covered, provided that I went to a participating provider and met the eligibility requirements. I’d also have to pay a deductible (based upon the entire year, not specific appointments and procedures) and 10% of surgery costs (which I’m guessing will be somewhere in the range of $2000?).
But that was two years ago, and a lot has changed between then and now. Namely, the economy. Also? My husband’s company is cheap, and after reading about many people finding out that their weight loss surgery would not be covered because their employer didn’t pay for it for the company’s health care package, I wondered if that might unfortunately be the case for me. Fortunately, it’s not. Next to me is a thick booklet titled “Certificate of Coverage”, and it’s for 2009. On page 46, under the list of exclusions, is the following (the emphasis is mine:
For treatment of obesity and/or morbid obesity, except for surgical treatment of morbid obesity
Well, that’s a sigh of relief. My plan still covers weight loss surgery, and backs up what a rep told me over the phone and in writing two years ago.
I have chosen a center of excellence for my surgery, which means that they are preferred/recommended/almost always covered by Capital BlueCross. I also more than qualify for surgery, since morbid obesity is a BMI of 40 or greater, and mine is around 47.
Logically I know that my insurance company will approve it. I have done everything as directed by the center of excellence, I have the backing of a surgeon and several nutritionists and dietitians, and they themselves said that Capital BlueCross and other BlueCross subsidiaries rarely give them any trouble. But still, until the approval is official, I am going to be edge, and holding back from fully “preparing” for surgery, since there’s still the uncertainty.
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