BCBS of TN - Denying Coverage?

[DSMCasey 15]

Hello,

My wife and I are both wanting to get sleeve surgery but our insurance apparently doesn't cover anything these days. I even have high blood pressure and a Hiatal hernia. My PCP actually referred me to the weight loss surgeon too!! Anyway, neither of us have ever had surgery in our lives and are pretty heartbroken about the whole ordeal.

I've looked all over the website for blue cross blue shield of TN and I don't see anything about WLS not being covered. There is an explanation of benefits form but its apparently not available to be viewed online for our plan. When I do a search I see that no one else apparently has trouble getting BCBS of TN to pay. Some have to go on a diet plan for 6 months, but I wasn't even given that option.

Any ideas on where to go from here? I have an email into the insurance company already. But if they told my doctor "NO" they are probably going to tell me NO as well!

I'm located in Dallas, and have some of the best WLS surgeons right at my finger tips!

Can I fight this? Can I actually win?

[awold0 246]

Hello,

My wife and I are both wanting to get sleeve surgery but our insurance apparently doesn't cover anything these days. I even have high blood pressure and a Hiatal hernia. My PCP actually referred me to the weight loss surgeon too!! Anyway, neither of us have ever had surgery in our lives and are pretty heartbroken about the whole ordeal.

I've looked all over the website for blue cross blue shield of TN and I don't see anything about WLS not being covered. There is an explanation of benefits form but its apparently not available to be viewed online for our plan. When I do a search I see that no one else apparently has trouble getting BCBS of TN to pay. Some have to go on a diet plan for 6 months, but I wasn't even given that option.

Any ideas on where to go from here? I have an email into the insurance company already. But if they told my doctor "NO" they are probably going to tell me NO as well!

I'm located in Dallas, and have some of the best WLS surgeons right at my finger tips!

Can I fight this? Can I actually win?

So you have TN blue cross blue shield but your in Dallas tx? Am I reading that right. I have bcbs in texas and was covered.

[knitlil09 91]

It all really depends. You need to request a copy of your coverage if you can't get it online. I have bcbs of Texas and was able to view my specific plan online.

All plans are different, so just asking if that company covers it won't help. I know many people who have been covered by bcbs of Texas but my specific plan does not cover it. It is an exclusion. Basically my employer decided not to have it included and there is not much I can do about it.

Get ahold of your specific plan and there should be something in there discussing wls.

[DSMCasey 15]

Hello,

My wife and I are both wanting to get sleeve surgery but our insurance apparently doesn't cover anything these days. I even have high blood pressure and a Hiatal hernia. My PCP actually referred me to the weight loss surgeon too!! Anyway, neither of us have ever had surgery in our lives and are pretty heartbroken about the whole ordeal.

I've looked all over the website for blue cross blue shield of TN and I don't see anything about WLS not being covered. There is an explanation of benefits form but its apparently not available to be viewed online for our plan. When I do a search I see that no one else apparently has trouble getting BCBS of TN to pay. Some have to go on a diet plan for 6 months, but I wasn't even given that option.

Any ideas on where to go from here? I have an email into the insurance company already. But if they told my doctor "NO" they are probably going to tell me NO as well!

I'm located in Dallas, and have some of the best WLS surgeons right at my finger tips!

Can I fight this? Can I actually win?

So you have TN blue cross blue shield but your in Dallas tx? Am I reading that right. I have bcbs in texas and was covered.

I WISH I had BCBS of Texas, unforunately my company is based out of TN and has BCBS of TN.