Blue Cross Blue Shield PPO

[fitflab25 0]

I have Blue Cross Blue Shield PPO insurence through my employer, I pay the most amount for the most coverage. It just kicked in may 18th, I called them to ask if they would cover for this surgery and they said no, but I can file for a appeal process... Has any one been told this and so on? What can I do, or whats happend to you? I have been on a monitored weight loss programe with my family doctor useing Adipex and I lost like a total of 15 pounds since Februrary.. Ive been approved for gastric by the military before but chickend out of the drastic process... I need all the info and help I can get. Also June 6th I attend a King Daughters Med Center in Ashland Ky Lap Band seminar for the first step of this process.. This weight is the wall I gotta tear down to accomplish my career dreams and goals....:thumbup:

[Debbie1955 0]

I have the same kind of insurance (also from Ky). I was told by my doctor to call and ask my insurance co. "if they pay for wieght control surgery for Morid Obesity." The lady I talked to even read back that my policy states it will pay for WLS for morid obesity. Maybe it was the way you asked and that is why they told you that you could appeal it. I am not sure what the difference would be but I would keep trying.

Good Luck, Debbie

[fitflab25 0]

I have the same kind of insurance (also from Ky). I was told by my doctor to call and ask my insurance co. "if they pay for wieght control surgery for Morid Obesity." The lady I talked to even read back that my policy states it will pay for WLS for morid obesity. Maybe it was the way you asked and that is why they told you that you could appeal it. I am not sure what the difference would be but I would keep trying.

Good Luck, Debbie

Thanks maybe it was the way I asked, But she said that my employer dosent pay for that benefit or something like that but if I try to get approved then they denie me just appeal it. I dont see why she would even say for me to appeal it if theres no use? I dont know I can just go to the seminar let them run my insurence and go from there I guess.. Maybe call again knowing my luck I got some one who didnt want to do the digging to get me the correct answer. LOL

[OpenHrtOpenMind 1]

Try not to be discouraged :thumbup: I think Debbie may be right in that it was possibly the way the question was worded. We have BCBS Federal & it has covered nearly about 90% of the entire cost including all the pre-op work ups, tests, & visits & even surprisingly the EGD (endoscope) which most insurances don't' cover (this procedure runs about $1175). Our Bariatric center had a insurance checklist that even contained the medical codes they use so we could reference these with our insurance company. You may see if they have something similar they could provide to you. In a pinch, here's the wording in our policy regarding what is covered:

"Gastric restrictive procedures, gastric malabsorptive

procedures, and combination restrictive and

malabsorptive procedures to treat morbid obesity –

a condition in which an individual has a Body Mass

Index (BMI) of 40 or more, or an individual with a

BMI of 35 or more with co-morbidities who has

failed conservative treatment; eligible members

must be age 18 or over. Benefits are also available

for diagnostic studies and a psychological

examination performed prior to the procedure to

determine if the patient is a candidate for the

procedure."

Maybe this can help to give you some more specific wording when you talk to the insurance company again :tt2:

[fitflab25 0]

Try not to be discouraged :thumbup: I think Debbie may be right in that it was possibly the way the question was worded. We have BCBS Federal & it has covered nearly about 90% of the entire cost including all the pre-op work ups, tests, & visits & even surprisingly the EGD (endoscope) which most insurances don't' cover (this procedure runs about $1175). Our Bariatric center had a insurance checklist that even contained the medical codes they use so we could reference these with our insurance company. You may see if they have something similar they could provide to you. In a pinch, here's the wording in our policy regarding what is covered:

"Gastric restrictive procedures, gastric malabsorptive

procedures, and combination restrictive and

malabsorptive procedures to treat morbid obesity –

a condition in which an individual has a Body Mass

Index (BMI) of 40 or more, or an individual with a

BMI of 35 or more with co-morbidities who has

failed conservative treatment; eligible members

must be age 18 or over. Benefits are also available

for diagnostic studies and a psychological

examination performed prior to the procedure to

determine if the patient is a candidate for the

procedure."

Maybe this can help to give you some more specific wording when you talk to the insurance company again :tt2:

Oh I forgot to mention this, at Kings Daughters Medicle Center in Ashland Ky Anthem Blue Cross Blue Shield even certified the surgeons and clinic for Lap Band and Bariatric surgery.. Dose that make any diffrence?

[darcynd 0]

Does it matter if it's Premera, or Regence or Horizon? I go through Premera BCBS and they told me it's considered plastic surgery and by any means they will not cover it. The DR's office said they sent a request of approval, and they still would not accept it. Any suggestions? Within the next 2 weeks, if they don't take it, then I'm paying out of pocket for the next few years! Good luck to those who have been banded, and to you Fit w/your insurance company!

[fitflab25 0]

I honestly dont know what to say if that makes any matter in this process?? I wish I could get approved finaces to pay out of the pocket Im will to do that but credit sucks thanks I need any luck sent my way and right back at ya, dont promise good luck sent from me though lol

[darcynd 0]

I completely understand. This month I'm getting myself out of debt. I'm going to keep trying tho, with getting approved (because they won't approve me yet) for the financing, and with my insurance company. I have been taking one of my clients on walks at least twice a week, and I try and find something strenuous to do around the house since gas is too high to drive to the park to walk for a half hour... I lost 5 lbs in the past 2 weeks from that alone. I'm afraid it will come back on, and I don't think these insurance companys understand... I still wish you the best of luck with your insurance.

[Tawna 0]

I have BCBS insurance as well. I have found out that after talking with them and starting the process that it would just be easier to pay out of pocket. My aunt went through the hoops and it took her 2 years to get the surgery... Hope this helps...

[fitflab25 0]

How do u expect to get financing if you think ur credit is bad ect?? I litterally am opening I high intrest saving account as we speak with INGdirect.com (compliments by suzie orman) To start saving, cause i know my credit jacked ughhhhh

[fitflab25 0]

I have BCBS insurance as well. I have found out that after talking with them and starting the process that it would just be easier to pay out of pocket. My aunt went through the hoops and it took her 2 years to get the surgery... Hope this helps...

Well ladies and gents LOL get this for the past two days my lower back hassss been killing me ahhhhh I was supposed to do a 16 hour shift last night at work but the pain was to much so im about to go to a chiropractor, Im litterally going to ask him if it has to do with my weight ect and if so Im going to ask for my first letter to send to the insurence company. Im going to save them up first and send them all the same time... Also I talked to the lady who used to deal with the insurence and such in human resources, however she said she couldent help no more in that dept I explained my question ect and she said theres no reason for them to denie me for this if it is medically neccessarry. So she is personnally contacting the women now in charge to look in to it... and make sure it is clerical error and if so correct my policy i guess??? Just updating you guys ang gals u think this is smart?