BCBS Oklahoma

[pinkbunies 359]

I thought I'd throw this out there for everyone.

I've had BCBS for years and they are against Gastric/Bariatric anything.

I was forced to switch to a new plan in December due to the affordable care act. My Premium was $161.00 a month. It went up to like $470. I had a $1000.00 deductible and found out that for $20.00 more I could get 0 Deductible, so I did that.

I got my new packet in the mail and the ACA did get rid of a ryder that said nothing related to my back, neck or head would be covered. So I guess if I had a sinus infection, because its in my head/nose area, I'd have no coverage. So those are gone

I had high hopes that the ACA would also get rid of the NO Gastric/Bariatric treatment, but my hopes were failed. Some states do require that the insurance companies cover it, but unfortunately my state does not

Anyway, on to the whole point of my post... I got my new packet and it clearly states that BCBS will not cover anything relating to weight loss, bariactric surgery, check ups, procedures or anything relating to weight loss surgery including follow up care. Anything related to weight loss or weight loss surgery will be denied.

So I started thinking about this, and wondered if I asked my Psych doctor about Gastric Surgery and she put it in her notes and they found it, would they deny the payment to the psych doctor? Just some thoughts, but the main point of posting this is to let you know, if you have BCBS Oklahoma, be sure to read your policy if you have had weight loss surgery.

[pinkbunies 359]

And I thought I'd throw this in there too... why in the world does the insurance company want to deny a procedure that has been so successful in helping people lose weight and get healthy?

Certainly paying for heart medication, high blood pressure medication, diabetes mediation, sleep apna medication and more would be more expensive in the long run than just paying for the surgery. . I just don't understand why they provide no options what so ever. I even had asked BCBS about weight loss surgery and the lady politely said that its not the insurance companies fault I'm overweight. grrrr

[lulalove 12]

I have BCBS, have to check for

payment but predetermination did award the medical necessity. They do not issue authorization number as its only predetermination.

Insurances often view these procedures as experimental although the greater proof is that they work!

Also for nutritionist visits BCBS pays 100% of fee (no copay, dedictible, co-insurance) .. usually 30 min=$100 but they give headache for this procedure.

It all comes down to money. These procedures cost insurances 20k on average vs few visits to nutritionist.

[lulalove 12]

oh and it definitely depends on policy type. There are different levels. The policy my family has I made sure prior and it did say it covers bariatric surgery. I also called. As i answered above my policy does not do pre-auth only pre-determination....

[pinkbunies 359]

Is your policy through an employer? I purchase my policy directly from BCBS. I know some employee offered BCBS Ok Policies offer it, but if your going direct its not available. I bought the very best plan they had.

[lulalove 12]

you are right, I did notice the difference last year also

if employer offered but HRA also bariatric surgery is mot covered. Its outrageous considering the policies are about $300+ per month... Obama's Health Reform is cheap stakes "i did something for the country"

[Sharon1964 2,530]

... So I started thinking about this, and wondered if I asked my Psych doctor about Gastric Surgery and she put it in her notes and they found it, would they deny the payment to the psych doctor? ...

It depends. First, the vast majority of psych visits are paid with no notes to the insurance company whatsoever. Kind of like your odds of an IRS audit.

Second, should they request the notes, and the notes say, "Pinkbunnies is here today to discuss weight loss surgery" the visit will be denied. If the notes say, "Pinkbunnies is distressed by his health and is considering his options to help resolve those issues", then the visit will be paid.

Psych docs don't have to be very specific in their notes. Your psych can discuss all sorts of emotional issues related to weight without actually saying it's related to weight. Further, your doc can keep a separate set of notes called "process notes" (versus "progress notes") which are his/her own private thoughts about you, and in there they can make notes about weight. Those notes are protected by law and do NOT have to be released to the insurance company. The key is that they must be separate from their official progress notes.

I'm sure if you tell your psych these things, they will most likely keep your information safe.

[pinkbunies 359]

Yep. I just keep thinking what I could do with that extra $300 a month I'm paying. I don't agree with the way it works but that's another issue. I don't get any tax credit or subsidy. I make it a point to go to the Doctor now for every single ache and pain. I feel like I need to get use out of that policy I'm paying for each month. On a side note, I did manage to get my vehicle insurance down from $7900 a year to $1600 and I lowered my deductibles.

It's now the law that we have health insurance, it should also be the law that they cover EVERYTHING not just what they want. Just my opinion.

Also, I checked into buying health insurance for my company and thought it would save me money. Nope. From what I understand, the employer pays a percentage of the claims filed. I'd never open myself up to a liability like that.

[Sharon1964 2,530]

Also, I checked into buying health insurance for my company and thought it would save me money. Nope. From what I understand, the employer pays a percentage of the claims filed. I'd never open myself up to a liability like that.

Maybe it's a state difference. Here in California, our company has zero liability for medical claims. We pay the premiums only. If I were you, I would speak to another insurance broker to make sure (one that handles more than one insurance company). The only time I am aware of that a company has any liability is when they are "self-insured", which means they basically hire an insurance company who is called a TPA, or Third Party Administrator, to process the claims. Often the big name companies (like the Blues) do handle TPA duties.

[pinkbunies 359]

@@Sharon1964 that's awesome to know. I've already had my surgery so no worries for me. As far as the business insurance goes, I just nixed the idea altogether. I haven't looked into it again since around 2011.