blue cross blue shield

[Lap_dancer 8]

Ain't it the truth.

I called Empire BCBS about 10 weeks ago when I began this process and asked them to kindly mail me their bariatic WLS requirements. They told me that I must submit a request in writing, via mail. I did and until TODAY had not received a thing. In between, I called to see when I can expect a response. The rep had NO clue and said "we don't do that". Hummm..okay, then how do I find out the requirements?? She put me on hold for 12 minutes and then said she would transfer me to a case manager....but that it was almost quittin' time and they may not pick up! LOL. I admired her honesty.

A case worker did pick up and discussed some details with me but was not comfortable with our conversation as I was the PATIENT and not the surgeon's office. I was as calm and kind as could be and explained that I wanted to meet all BCBS requirements, which may include (as I'd heard) a 6 month supervised diet...and if that were the case, I'd like to make sure I got started sooner than later so can I PLEASE have the requirements. She said she wold read them to me. Not ONCE was a 6 month diet requirement mentioned. I kindly thanked her and noted her name, date & time of call.

4 weeks later I get the documents! The cover letter had some details of my coversation with the case worker (Judy) as well as a plethora of info on bariatric surgery and coverage. If I had a scanner I get it up for you all....but that will have to wait until work on Monday. Oddly, it was signed my a gentleman named Walter(not Judy) whatever.....

According to the documents, I meet the requirements and have all my paperwork in order. Now, to get the surgeon's office to get it to BCBS and in "the system"........

Please feel free to e-mail me at maltomeel@optonline.net if you have Empire BCBS of NY. I will provide any info I can to make this whole thing easier for all.

Jill in NY

In for the long haul

You have a right to a copy of your insurance policy. This is no grand request and no mystery that is exclusive for the doctor's eyes only.

[maltomeel 0]

Awesome Bean! We are on our way! You have done so well on the 6 month diet...you are gonna kick butt.

Congratulations!

[piercedqt78 658]

You have a right to a copy of your insurance policy. This is no grand request and no mystery that is exclusive for the doctor's eyes only.

I had to request my copy from the employer. ~Mandy

[NimbleBean 2]

Maltomeel,

Thanks for the encouragement and CONGRATS to you on your approval. Now we can both start the next phase of our journey. I'm hoping for April 18, but my surgeon may already be booked. Keep me posted on your date.

:gluck:

to us both!

NimbleBean

August 2006 - 285

March 2007 - 241 (after 6 month medically supervised diet)

? - 140 goal weight

[airwayman 2]

I know I've railed about BCBS in previous posts. I said the first word they learn is NO!! But I've changed my tune. I started this journey in January and FINALLY completed all the requirements last Thurs. when the Dr's ins. guru faxed my folder to BCBSNC. That was on Thursday, midday. Saturday, two days later, I get a snail mail, not a fax, not a phone call, not a FedEx overnite letter, a snail mail from BCBS APPROVING my request and wishing me good luck. Must be some kind of record. JB

[rcoeters 0]

BCBS of NC started covering Lap Bands Jan 29, 2007. Hopefully, OK will follow suit shortly.

[momashed 0]

I have bcbs {in IL} its going to covered everthing, but I had to jump alot. 1 thing was go to the doctors 1 a mo. for weight for a year.

[TracyinKS 7]

I know I've railed about BCBS in previous posts. I said the first word they learn is NO!! But I've changed my tune. I started this journey in January and FINALLY completed all the requirements last Thurs. when the Dr's ins. guru faxed my folder to BCBSNC. That was on Thursday, midday. Saturday, two days later, I get a snail mail, not a fax, not a phone call, not a FedEx overnite letter, a snail mail from BCBS APPROVING my request and wishing me good luck. Must be some kind of record. JB

CONGRATS Airwayman!!!!!!!!!!:clap2:

[stacyann39 0]

:help:I am currently considering obtaining insurance through BCBS. I live in Missouri but will be getting married and moving to Kansas June 1, 07. While getting basic info on their websites, I read in the exclusions page that lapband surgery is not covered. Have any of you been covered in a plan in Mo or KS and what plan exactly was it, as I see they have several types. The insurance mt fiancee has in TriCare as he is retired from the navy, but have been told forget it about them ever covering this type of surgery, so I am looking at other companies for me. I have not seen a doctor in years except for Migraines and weight loss has never been discussed with any doctor. Any suggestions of things that i should do NOW before even enrolling in any type of insurance to make this process smooth ( like there is anything smooth dealing with insurance lol..) thanks for any help and god bless

[airwayman 2]

Ihave not seen a doctor in years except for Migraines and weight loss has never been discussed with any doctor. Any suggestions of things that i should do NOW before even enrolling in any type of insurance to make this process smooth ( like there is anything smooth dealing with insurance lol..)

Stacyann, I live in NC so I can't help with MO and KS. Many, if not all, of the BCBS companies have their own individual policies. So, best answer is, it depends. In NC you'd be sc***ed because you said you haven't seen a doctor in years. The NC policy has recently been changed to allow gastric banding but one of the qualifiers is you must provide medical proof of your morbid obesity for at least four of the last five years. If you haven't been weighed in a doctor's office in years I don't know how you could get around this requirement. However, I've read that some BCBSes don't require proof of a weight history, instead, they require a medically supervised diet for six months. Remember, it takes two to Tango; if you are using an ins. policy provided by your employer, or your spouse's employer, both the ins. company AND the employer's policy must allow gastric banding. I've heard that some ins. companies allow gastric banding but the company declined to purchase that option. In that case, the fight would be with the company human resources dept. not the ins. company. Good luck. JB

[stacyann39 0]

Thank you much for your help....I currently do not have any insurance and am getting married this summer and will have Tri-Care through my husband. I was thinking of purchasing BC/BS on my own as I have heard many say they are easy to work with...I guess I should start by seeing my doc, although he has never mentioned me losing weight, I am going to talk to him about what i want to do and get on a program with him, i think thats a good first step, and to also investigate ALOT about the policies available to me and the options. Thanks so much for your help...Be Blessed,

Clay in his hands,

Stacy

[airwayman 2]

I currently do not have any insurance and am getting married this summer and will have Tri-Care through my husband. I was thinking of purchasing BC/BS on my own as I have heard many say they are easy to work with...I guess I should start by seeing my doc, although he has never mentioned me losing weight

Couple of thoughts....one, if your husband has medical ins. and you are only purchasing BCBS for the possibility of having bariatric surgery, you might be better off to self pay. Secondly, you said your doctor had never mentioned your weight. Many doctors never mention weight...they don't want to hurt the patients feelings. Really. I have several doctors for various ailments. One has vaguely mentioned weight loss. Stacyann, get on the scales. Measure your height. Google on BMI or find a BMI chart somewhere on the zillion sites related to weight control. Run your finger down the weight column and the height column and get the truth. Not knowing is akin to sticking your head in the sand. If your BMI is over 40, there's a time bomb ticking inside you. Don't mean to scare or ridicule you. Just want you to live a long and healthy life. Morbid obesity kills people every day. JB

[ard 0]

Hi Everyone,

After my fact finding mission, the final answer is that my doctor was correct. My job is a small company which means our insurance policy doesnt cover everything 100%. But the good news is that my doctor has me scheduled for pre admission tests on Thursday and I have my surgery on Monday 4/16.

Thank you guys for your help.

[TracyinKS 7]

:help:I am currently considering obtaining insurance through BCBS. I live in Missouri but will be getting married and moving to Kansas June 1, 07. While getting basic info on their websites, I read in the exclusions page that lapband surgery is not covered. Have any of you been covered in a plan in Mo or KS and what plan exactly was it, as I see they have several types. The insurance mt fiancee has in TriCare as he is retired from the navy, but have been told forget it about them ever covering this type of surgery, so I am looking at other companies for me. I have not seen a doctor in years except for Migraines and weight loss has never been discussed with any doctor. Any suggestions of things that i should do NOW before even enrolling in any type of insurance to make this process smooth ( like there is anything smooth dealing with insurance lol..) thanks for any help and god bless

TriCare covers the RNY but not the Band........... BCBS of Kansas City, or BCBS of Kansas all list it as investigational but will cover if medically necessary.. PROVIDING your employer DOES NOT HAVE AN EXCLUSION

[Kristin07 0]

Hello everyone!! FYI I have BS of California Shield Spectrum PPO plan 750, I called them today and they told me that they just started covering the Lap Band March 29th. I am so excited! They also said that a Dr needs to say its Medicaly necessary. (hello of course they will!) Then u need to meet with a nutritionist and have a psych eval. No 6 month supervised diet. Thank god! So just wanted to let everyone know! Wish me luck hopefully everything will go smooth from here on out!