Question:
Has anyone sucessfully managed to get WLS approval from a self-funded insurance?

Has anyone sucessfully managed to get a self-funded insurance company with a policy exclusion regarding WLS to pay for surgery after appeal procedures?    — Vicky B. (posted on January 16, 2001)

January 15, 2001
Hi: Yes, I was able to get my self insured employer to change its exclusion. I went directly to the HR heads and showed them all my backup documentation. They told me to send it off to the review team at the insurance. I was approved. I know they must of gotten involved with the insurance once I did this so that it would be changed. Feel free to contact me if you want the specifics. Good Luck
   — Karen A.

January 16, 2001
Yes, I worked with my Health Benefits Manager and the company agreed to have my surgery approved "off contract." I focused my request on my medical needs which included hypertension, hypothyroidism, osteoarthritis, sleep apnea, a family history of heart disease and hypertensive-induced vascular dementia. I also explained my research (14 months worth) and explained my decision-making process in deciding on surgery and which surgery and which facility I wanted to use. As a consequence, I was approved for an open RNY at BTC in Belvidere specifically. I found that once I found out who the person was who could say "yes," I was able to engage her as a partner in the process rather than an adversary.
   — Nanette T.