Been reading my insurance booklet...grrrrr!

nanahanna · December 29, 2005

I got a copy in the mail today and it says under Exclusions:

"Weight reduction programs or treatment for obesity including any surgery for morbid obesity or for removal of excess fat or skin following weight loss, regardless of Medical Necessity, or service at a health spa or similar facility".

So...do I still get my doctor to send a letter of Medical Necessity and try to fight it?

Thanks!

Sharon

KarenA · December 29, 2005

I would still try.

I did not face this, but maybe someone on this site has run into the same thing and found a way around it.

nanahanna · December 29, 2005

Thanks Karen! I also forgot to mention that my husband's work place is self-insured and BCBS of MS administers it.

Sharon

ReneBean · December 30, 2005

I THINK that if they are self insured - you can go to the employer and see if they will cover it for you. Blue Cross only administers what the employer is willing to pay for, so if the company won't issue you a special authorization or something, I think you are stuck.

:[

nanahanna · December 30, 2005

Thanks Rene. I may have to do that. Funny thing one of the owners of the company is an email buddy of mine...I might approach him about it. LOL..that might be the end of the friendship! But it is ridiculous that they have spent no telling how much on me in Drs. appointments, lab work, meds, procedures etc. because of my diabetes, hypertension, arthritis and diverticulitis...they should look at that and realize in their thick skulls that if they would help us get this surgery, we probably wouldn't be that much expense to them ever again. I don't get it!

Sharon

nanahanna · December 30, 2005

Rene, I wrote him an email! I will keep you posted on what he says!

Sharon

ReneBean · December 30, 2005

Coolness! Good luck!

nanahanna · December 30, 2005

He said he would get back to me soon and that it was not an easy question to answer. I know he will get back to me...he always has when I have asked questions before. Maybe I can stir up some dialog among the powers that be on this subject! I will keep ya'll posted!

Sharon

porclndoll · December 31, 2005

Sharon....This is what I think....I worked for BlueCross BlueShield for several years....things have changed since I have been around, but your not doing this "just" because your obese...right? You more than likey have some underlying medical condtions that need to be focused on such as high blood pressure, or diabeties, or sleep apnia... Am I right? Have your doctor mention all those things in your initial letter for predetermination.....then fight with your levels of appeal....The exclusion said Weight reduction programs or treatment for obesity including any surgery for morbid obesity or for removal of excess fat or skin following weight loss, regardless of Medical Necessity, or service at a health spa or similar facility With LapBand surgery other conditions may be benefitted.....

nanahanna · December 31, 2005

Hi porclndoll! Yes, I have diabetes, high blood pressure, some asthma (only seasonal), and psoriatic arthritis. I sent an email to one of the owners of the company my husband works for (they are self-insured and BCBS administers for them) and asked him why they don't pay for it, that I desperately need it and that my medical conditions (I spelled them all out)would be definitely improved and maybe even go away if I could lose the weight. He is an email buddy of mine and so I felt comfortable asking him. He wrote back and said that the company had been absorbing huge costs already instead of passing them along to employees (they did try to get the union to approve some changes but the union voted it down) and that our insurance is geared to helping pay for illnesses and injuries that are not in the insured person's control and not conditions. In other words he was saying the company thinks being overweight is something that the person can control. Hmphf! Oh well, I am going to go ahead and get my doctor to send the medical necessity letter and see what happens.

ReneBean · December 31, 2005

Good luck, Sharon.

nanahanna · December 31, 2005

Thanks Rene, I am going to need it! Hey, I got on disability the first try with lots of prayer and God's help...maybe He will come through again for me!