BCBS - What are they thinking?

[maryb 1]

I met a nice lady today in a line at a salad bar/buffet. I was behind her and picked up only a small plate. She picked-up the platter and small plate. She said your not having much, why don't you get in front of me. I said I am getting a baby plate of food.

Then I thought the way I said it she might think I was getting it for a baby, so I confessed to having lapband surgery. She asked my how it was going for me. I let her know it was going great and that I had lost 40 pounds in 3 months. She asked me if insurance paid for mine. I told her no that my BMI was under 40 and only one co-morbity. I told her if I had two they would. She asked me what insurance I had. I told her United Healthcare. She said her BMI is over 40 and she has 2 co-morbities, but BCBS denied her. I felt so bad for her!

:angry

What is wrong with BCBS! With just losing 40 pounds, my osteo-arthritis has improved, my allergies have improved, my sleeping pattern has improved, and I no longer have border-line high blood pressure. I got all this by investing $15,000.00 into my lapband. We all know the insurance companies negoticate for a better price. Don't you think it would be a good investment for their company to cover this surgery? We are reminded all the time of the billions of dollars in health care costs related to Obesity. Let us have some Preventive Care!!!!!

OK, I am through venting now!

[MelodyJ 0]

I AGREE!!!!!!!!!!!!!!!!!!! BC/BS are poops!!!!!!!!!!!!!!!!!!!!! They wouldn't cover me either....but like you felt I was worth it and so did my husband!!! We just wrote the check and I am SO HAPPY!!!!!!!!!!!!!!!!!!!!

God Bless,

Melody

Banded 3/20/06 -52lbs :confused:

[michele6789 0]

They also denied me but I am trying to appeal. I hope eventually that they will not say that it is experimental. They will pay for gastric bypass though and that costs them quite a bit more. :confused: I actually had a lady at the insurance company ask me "why I didn't just do gastric bypass"!! What a jackass:biggrin1: , thanks for letting me vent. I will also be self pay if they don't pull through which I'm sure they won't.

Michele

[casb37 0]

To michele6789 and countless of others that have BC/BS, I to have this crappy insurance and I was denied 3 yrs ago. I have did countless appeals, got together with my co-workers and Human Resource tried having the benefits coordinators change the policyexclusion even wrote our congressman and I have not had any luck. If anyone got approval through an appeal thru BC/BS please reply back immediately I so want to know exactly what procedures you took inorder to get the approval.

[Alexandra 55]

BCBS is not one organization, and I know of several states where Blue Cross/Blue Shield covers the band readily for qualified people whose contracts allow. It's not all BCBS organizations that deny coverage.

So, anyone reading this, don't assume that what's true in one state is true in another! Find out what's the case in YOUR state, and take it from there. And good luck!!!

[MarianneTN 0]

To the previous poster's point...

I have BCBS of TN and got approved within 10 days of submitting my paperwork to them. I do understand as of May 1st they have added a few more requirements but are still approving surgery.

Edit: My surgeon's office has a list of the things required by each insurance company. They won't even submit your paperwork until each bit is satisfied. I had to supply 5 years of medical records, past diet history with supporting evidence (WW reciepts, doctor's RX for Meridia, etc), a psych exam, and so on. It was a HUGE packet they sent over. My diet history alone was 14 pages!

Just my two cents...

[maryb 1]

This is true....BCBS of Texas is the worst!

My Best friend has BCBS of California and was able to get hers approved in just a few weeks... of course she has had 4 back surgeries, 2 knee surgeries, 100+ pounds overweight, 3 co-morbities and is on disability because she can barely walk. She had letters from all 5 of her current Doctors.

[Elisabethsew 50]

I had to appeal the BC/BS decision not to pay for my lapband surgery and eventually won. I had 2 co-morbidities and a sky-high BMI but did not have the 6 month medically supervised diet. It was definitely an exercise in persistence but I won.

[maryb 1]

Good for you, Elisabeth! I did tell the nice lady in the salad bar line to not give up after one denial. I think she was discouraged because she was told she had to have at least 5 years of documented weight loss efforts in the past plus the extra six months Doctor supervised diet. How many people have this kind of paper work around? Not me...even though I have been on and off diets since I was 13... That is 35 years of diet failures!

[Mert 0]

Thank you to the state of Texas for providing the teachers with this sucky insurance.:faint:

I am in the process of sending and sending documentation to them. I faxed 20 pages of doctor notes and lab test results today. Had to fax it twice to two different numbers. Finally they said they got it. When do I give up and self pay a surgeon in MX? I don't have documentaion to back up years of dieting and failed attempts. I have PCOS and a BMI of 49. That they already know. Shouldn't that be enough?

BCBS of TX TRS Activecare...my family will be paying them premiums of $1115/month in the upcoming school year. What's up with this company?

[paula 4]

Its NOT BC/BS's fault...

most insurances exclude LapBand (AGB) because of the on-going expense related to this surgery (or lack of knowledge). RnY is -most of the time- just ONE surgery, thats why insurances push this procedure.

As you can read around here, in MANY patients - they require more then one surgery with the LaBand. Port problems, slips, erosion, leaks in tubing, etc.

It could get expensive!!!

So? Ins. Comp's simply choose to NOT cover this form of WLS. Has NOTHING to do with IF it works or not.

I have BC/BS of Louisiana (Fed) and I would LOVE for them to cover LapBand. But I completely understand WHY they (and so many others) do not.

Its still aggravating though!

[Mert 0]

I have BC/BS of Louisiana (Fed) and I would LOVE for them to cover LapBand. But I completely understand WHY they (and so many others) do not.

Its still aggravating though!

Paula,

I see from your signature line that you have had weight loss success. :clap2: What did BCBS do for you and how did you manage to get help? I am open to suggestions Thank you.

Mert

[paula 4]

Mert,

At the time of my surgery (July 04), I had First Health/MHBP insurance. They were awesome to deal with (easy approval and paid something like 90% of everything) - but they didnt have dental insurance!

~~with 3 kids, dental insurance is MORE important then Moms LapBand~~

So, in Jan 05 we switched to BC/BS La.:biggrin1: :biggrin1:

[Mert 0]

Paula,

I see. Well, I know where you're coming from I have two kids myself. I am happy for you for that weight loss. You must feel great and the kid's teeth are lookin' good too. Thats about as good as it gets. thank you.

mm

[MelodyJ 0]

I am a health care provider and feel they SHOULD cover obesity surgery... there are so many long term expenses related to obesity!!! But we are more into bandaiding than preventing!!!!

God Bless,

Melody

Banded 3/20/06 -52lbs :bananajump: