i'm sad, confused and hurt!

[amethystlady 0]

well, i went home and found my bcbs benefit book and found out what the customer service rep. told me was true. #20 states...the plan covers and will not pay services intended to treat obesity, such as gastric bypasses and balloons, stomach stapling and jaw wiring. i just knew that couldn't be true. but it's in black and white. so, is that that? can i appeal? am i able to appeal? or do i just give up the idea of getting this procedure through my insurance carrier. i'm hoping with my medical problems that i explained in my introduction earlier today, and maybe with the help of a concerned doctor/doctors i might be able to get it. what do you all think. is this Iron clad or can i protest with an appeal. if i can't, i can't. thanks for listening.

[chimboree26 24]

well, i went home and found my bcbs benefit book and found out what the customer service rep. told me was true. #20 states...the plan covers and will not pay services intended to treat obesity, such as gastric bypasses and balloons, stomach stapling and jaw wiring. i just knew that couldn't be true. but it's in black and white. so, is that that? can i appeal? am i able to appeal? or do i just give up the idea of getting this procedure through my insurance carrier. i'm hoping with my medical problems that i explained in my introduction earlier today, and maybe with the help of a concerned doctor/doctors i might be able to get it. what do you all think. is this Iron clad or can i protest with an appeal. if i can't, i can't. thanks for listening.

First, I want to say welcome to LBT! This is an awesome site w/some wonderful people and great support and advice. I saw your other thread, as well. I'm sorry your insurance doesn't cover it. I personally would still get w/my docs and submit. Then, if you're denied, you can appeal. I know there are some other threads on here about appeals.

I wish you the best. Just don't give up the fight now.

[lindaa 1]

I hear you, and it just blows my mind how insurance companies discriminate against the obese. What makes me really mad is that in my state Welfare patients can get gastric by-passes, but even after working for full-time for 21 years, I can't. You might look into going to one of the hopsitals in Mexico where the cost is less than 1/2 of what it is in the USA or Canada.

[cookielover 1]

I know how you feel, in Canada where I am from our insurance does not cover lapband proceedures, so it is all me baby. I sold my house to pay for this...it is that important. I can get a new house, but if I die from my weight it is game over. And if I didn't have a house to sell, I would be in debt (via credit cards) up to my eyeballs.

You can't give up. It is only money. This is life or death.

I am there with you and I feel your pain. Good luck.

[Big As Life 0]

You can appeal....I knew a girl that was denied six times and each time she just would put in another appeal and finally they approved her...I guess they got tired of hearing from her...whatever it takes....I just went ahead and paid for my own...the insurance co. just flat out said NO>>> so I just self paid...and so glad that I did...

[amethystlady 0]

thank you all for your helpful comments. i really do appreciate that there's others who know exactly what i'm going through. i am so happy i join this informative forum, what a blessing. on my next day off i'll get an appointment and see my primary care physician at kelsey seybold main campus here in houston. so, when i see her what is it should i say? i know i'll let her know i'm interested in getting the lap-band procedure, do i tell her that bcbs doesn't cover it but i still want to go through the steps so i'll have it under my belt when and if i have to appeal? would she know the steps? i think i know them and if i get stumped i'll have friends here who can assist me. i really think i'm going to appeal. i know it will take time, but maybe by this time next year in my 50th year of life, i'll finally can take control of my weight and health. that's what's important. thank you all, margaret

[claramae 0]

My insurance(same as yours) will not pay unless I have 6 months of history of going to the dr for weight counceling. My dr. has been harping at me for 25 years, but not good enough for ins.co. I am on disability now and on Sept. 1, I will be on medicare. That is why I wanted the ins. to pay because medicare will not. Ins. knows this and that is why they denied me. Oh, well, I want to live a long time, so we are coughing up the money ourselves. It is a shame with the high premiums we pay for our insurance. Keep trying with the insurance co. and good luck.

[Klover Dad 0]

I would encourage you to do whatever is financialy/physically feasible (and legal) to get this procedure as soon as possible. A healthier, lighter, you, will give you opportunies you only dream about now. Dump BCBS - they don't care about YOU.! The best I've heard of is 20% (AFTER you jump through a bunch of hoops and pass a multitude of demeaning roadblocks!).Time we stood up to these short sighted insurance people, whom seem to prefer paying 80% for weight related problems than keeping us, healthier, longer living, premium payers. I just don't get it!? I wish I were wiser, in business maters, and had some money to help my fellow/future 'Banders'. There are just too many of us for some kind of 'credit union-like' loan company not to work. Every time you bent over and tied your own shoe; you'd thank-the-bank...wouldn't you? Sorry, I got off on a tangent and ranted a little bit.... but ALL of you know what I mean. Best of luck, A'Lady, Dylan

[SD Chick 0]

I know exactly how you feel, until January of this year bcbs did not cover LapBand in the state of SD but low and behold now they do and I found out about it in Feb and started working on it that day. Today I am very happily banded and it only took 5 days from the time we faxed all the info to them that I was approved. Of course there has to be medical necessity for them to cover but I have diabetes, highblood pressure, etc, etc. and the BEST Part - I have been off my diabetes medicine since the day after surgery and my blood sugar is better than it ever has been. I know it is hard but try to be patient if you can and HOPEFULLY they will change their mind!

[mceni 0]

Hi There,

I know how you feel, I was not covered by my insurance company either, I was very excited and then the letter came. that was a year and a half ago. I thought about it, and finally came to the decision that this surgery was well worth the cost of a car. I took a loan on my 401k and will be banded on August 23rd. I know it seems like alot of money, but you are worth every penny.

Keep your chin up!

[MeganAnn 0]

As a person who works in insurance for a living, I can tell you first hand, that if your insurance says that it is not a covered service, your done. There are no appeals. There is a big difference in the them denying your claim, and you appealling 6 times, and them finally approving, than the statement that it is flat out not a covered service. Unfortunately, it's the big name insurance companies that are doing this. When you think Blue Cross Blue Shield for example, the immediate general thought is that it must be great insurance. It used to be. Over the last couple of years BCBS has really starting declining in their coverages, raising copays and deductibles, and denying services. If you have any sort of choice in your insurance or possibly by coverage through your spouse, check into it. I was very lucky. I have Humana HMO-that's right, an HMO and they cover it, and it took only one time. My only out of pocket was a $200 surgical copay. Another thing you do, is check with several physicians on their cash price. I know that my insurance wa billed nearly $26000 for everything. My Dr's cash price which also includes everything, $16000. For the average Joe, still not affordable, but more doable. Good luck. It will be a hard journey, but you will succeed. Keep your head up.

[Nettie 1]

I will be going for my consult on Aug. 28th and I have no medical insurance. I have decided to withdraw my retirement savings to cover the cost of my surgery. I look at it this way.... I am 32 years old, if I don't have this surgery I may not make it to retire. So yes, it's a lot of money, but when you think of all the other things we are willing to fork out the dough for, it's worth it! (I HOPE) It is a scary thought, but God will provide! :glasses

[djmath 0]

I wish you luck with your insurance company, I think it really depends state to state with BlueCross...where I live..in MN it was a covered procedure,however I did have to have documentation that I had had a weight problem..and I had great support from my primary doctor,she told me what can I do to help you get this done when I approached her, there was no problem with my BlueCross when I supplied the documentation of fighting my weight for year...my advice to you...submitted it to insurance, I would think that the drs nurse would be able to help you with this....my surgeons nurse did all this, got the documentation from me and got the approval that was needed..if you get a denial I say..appeal it with as much documenation as you can get...from your doctor about your health..and the benefit to you health that it would be......I work in an hospital billing office and do appeals on different procedures...as much documenation that you can send the better.....

I wish you luck with this...don;t give up...you are on your way to a healthier you!!!

Jenny:)

[amethystlady 0]

thanks everyone for your input and encouragement. i will not give up. we will be changing our insurance providers soon and i will look at them all and see if wls is covered, i'll they do i'll get rid of bcbs. i will continue to see my pcp so evertyhing is documented, so on and so forth. thanks again. i really enjoy this forum!

[DecemberRose 0]

I have Aetna insurance. They don't cover the surgery either. But, in Georgia, where I live there is a state mandate that says if your doctor says that your health is in jeopardy from being morbidly obese for over a year, then they will cover the procedure 80%. I have to pay the other 20% and a $500 co pay. See if you have a state mandate.

Cherie