blue cross blue shield

[TracyinKS 7]

LD: YOU ARE SO CLOSE TO WINNING!!!!!!!!!!! I CAN SMELL IT!

I will say a prayer for you and cross my fingers and my toes (and my eyes) that you get this approved!

[airwayman 2]

I have to agree with Tracy on that backwards comment. If they cover weight loss surgery but don't consider Lap Band weight loss surgery than what do they consider weight loss surgery?

All of the gastric bypass type surgeries, the only one excluded is gastric banding, their word for Lap-Band.

[airwayman 2]

My husband is fond of saying...AW what the hell, let's appeal it just to mess with them!Hahahha.

Yes, but aren't you allowed only a certain number of appeals?

[Lap_dancer 8]

Yes, but aren't you allowed only a certain number of appeals?

Yes.

I followed my right to an appeal but the wording in my contract was such that it was obvious the surgery is an exclusion. Even I could see that.

My fight was not with BCBS, it was with my employer who took out my insurance policy. My position with my employer was very simple, I have a disease, there is a treatment plan, my doctor recommended it, I qualify for it, passed all exams in preparation for it but can't get it because our contract excludes it. I requested my employer pay for the procedure, adding a rider to my policy. (we have large group insurance. I cannot change the policy that my employers took out, only they can change it)

I specifically requested they "amend my policy to include gastric surgery".

[airwayman 2]

My fight was not with BCBS, it was with my employer who took out my insurance policy

My case is different. My employer's policy covers WLS, doesn't say what kind, only that you have to qualify for all the reasons we've all heard a thousand times. It's the BCBSNC policy that specifically excludes gastric banding. I'm on it and will have it out with BCBS-NC, thanks to you and others who have provided me with a wealth of information. I thank you for all you've done. We'll see what shakes out. JB

[synicalchick 0]

Can someone out there tell me that has self paid, but kept fighting the insurance and won.. how that works? do you get reimbursed?

I got my 1st denial and we are now in the 1st appeal process. My DH is telling me that if in a week or two that haven't approved it he wants us to go ahead and self pay... keep fighting the insurance and get reimbursed. Is there anyone out there that has done this? How do they reimburse you? Does the insurance company pay you or the hosiptal???

Thanks

:laugh First Consult: 1/3, 2007

Viewed online 'seminar' 1/3

:grouphug: psych eval test 1/3

:confused: Appt to discuss Psych eval results 1/15

:clap2: Dr. Morton's office called to tell me they faxed my 300+ pages to BCBS 1/19

:faint: waiting.. waiting and well.. waiting some more:pout:

got letter from BCBSof TN that I'm not fat enough to qualify for the procedure (summerized by myself of course) 1/30 the day before my 37th bday.

Starting appeal process 1/31.. my 37th bday

:high5: :peace: Insurance approval________?:dance: :laugh :banana

first meeting with internist at surgeons office ____?

Surgery date_______?:nervous

[chubbola 0]

Okay

Here is my news.

You all know I followed my BCBSFL appeals process all the way to the top and then called the State Dept of Insurance regarding my denial.

The denial was based soley on my employer's policy. They have an exclusion for gastric surgery. It's as plain as the nose on your face.

I was told by one employee of BCBS that the employer could buy the inclusive procedure and add it to my policy. SO... I called employee benefits and explained, sent copies, and contacts at BCBS, and then got an appt. to sit before the Insurance Committee to request the purchase of this to my contract.

This happened on Wednesday.

I felt so calm, like I had nothing to lose (but my weight). This committee made me feel welcome. One half hour turned into an hour. I don't think there was one person on that panel who couldn't relate. We all know people who try and try to lose weight in vain. I told them my story and then I showed them my ziplock bag of 9 medications I take each day.

My request was a first. They didn't know if it was doable, BCBS reps were present and said they could draft the inclusion and would have it within a few days. One person was checking with the attorney to see if there was a problem, and the other was checking with the Board for expenditure approval. They will reconvene on Feb. 15th to submit findings.

I'm feeling really good about this. :high5: :high5: :high5:

SWEET!!!!!!!!!!

i'll be waiting to hear the great news!!!! Keep us posted!!!

~~Courtney

[kwhenrykerr 0]

Go Go Lap Dancer

[TracyinKS 7]

I personally don't but I have read about others who have done so.....

Good luck with your decision and keep us posted.

Can someone out there tell me that has self paid, but kept fighting the insurance and won.. how that works? do you get reimbursed?

[Dana41 0]

I was just approved through Blue Cross Blue Shield Federal Employee Program, I am having my band 2/22/07. It was submitted to them 1/31 the approval was pretty fast.

[synicalchick 0]

I was just approved through Blue Cross Blue Shield Federal Employee Program, I am having my band 2/22/07. It was submitted to them 1/31 the approval was pretty fast.

WHOOO HOOO! HOOORAH FOR YOU!

[Lap_dancer 8]

Congratulations Dana! Way to go. So happy for you!!!!!!!!!!!!!!!!

[airwayman 2]

I'm trying to appeal to BCBS of Oklahoma for the lap band & am interested in BCBS's coverage of it in other states...anybody out there know???

See my new post. BCBS of North Carolina just changed their policy to include gastric banding (Lap Band).

[airwayman 2]

Some of you have heard my rant recently about calling a direct line to a BCBSNC representative that I have had good luck with in the past. I was upset that I had left her three voice mails in the past three weeks and she had not had the courtesty to even acknowledge my calls. Turns out she was in a BAD car accident about a month ago. Now, you'd think they would have someone checking her voice mails but, still, I feel a little guilty. Oh, okay, now that they have APPROVED THE LAP BAND SURGERY IN THEIR CORPORATE POLICY I guess we can kiss and make up.

[Lap_dancer 8]

Some of you have heard my rant recently about calling a direct line to a BCBSNC representative that I have had good luck with in the past. I was upset that I had left her three voice mails in the past three weeks and she had not had the courtesty to even acknowledge my calls. Turns out she was in a BAD car accident about a month ago. Now, you'd think they would have someone checking her voice mails but, still, I feel a little guilty. Oh, okay, now that they have APPROVED THE LAP BAND SURGERY IN THEIR CORPORATE POLICY I guess we can kiss and make up.

First...WOO HOO:clap2: Second...I have a feeling in the next 12 months BCBS is going to be doing flip flops changing their policies. Trust me.