BC/BS IL --- new rant

[KayleighsMommy 16]

Just got a call from my surgeons office. I am still reeling from the shock!!! They want 24 months medically supervised diet

WTH????? It's not like I need to lose 50 pounds. I am over 300 pounds, have high blood pressure, mild sleep apnea, diabetes, high colesterol, arthritis in my knees (almost crippling), chronic pain, a clotting problem and am on my third abdominal hernia.

I still can not believe this.

I expected a denial because of the 6 month diet thing.... but 24 months???? Are they freaking kidding me????

I am scheduled for surgery next Thursday... I am having my hernia repaired, we are going to self pay for the lapband ($5500.00). What the hell do I have insurance for anyway???????

Un-believe-able

[bandofhope 1]

I would be in shock, too... what was their reason? So sorry!

[Chris61 0]

Sorry to hear about your setback. I wish you the best of luck next week and hope that the doctor will do both at the same time for you. This might take some time but I bet if you go back through your medical records of all the doctors you have been to you could get all the information they are looking for, I would also have each doctor do a letter talking about your diets etc.

Chris

[afw 0]

24 months medically supervised diet is NOT for your health - it's for their bottom line. It's just a way of putting up a gigantic, basically insurmountable roadblock so that you don't send them the bill, and end up paying for it yourself. It's one thing if they just don't cover it because the policy excludes it; it's another if it purports to cover it but makes it impossible to ever get it.

Honestly, our health care system is so incredibly screwed up, it makes me sad for the future of our country. I read an article in the New York Times the other day about how many doctors are quitting medicine because they don't get to actually practice medicine anymore; it's all paperwork and bureaucracy. I'm very lucky to have insurance that covers Lap-Band without many hoops to jump through (no supervised diet requirement at all), but it's just that - pure luck. Access to health care should not be governed by luck.

[Lunabeane 2]

Is the 24 months medically supervised weightloss a requirement of your surgeon on the insurance company?

[nazzy 1]

i have bcbs michigan and all i needed was a 6 month diet from my dr,weird

[hudsonhurricane 0]

Thats not as bad as it sounds .My surgery was may 15 th and it seemed like it was never going to happen, I had to come up with 5 years of medically

supervised diet .I was a Medicare patient with COPD and a BMI of 48 .

Call your primary care and ask him to help you he just put notes on his letter head with dates of my visits and my weight for 2 years thats all they are looking for showing that you were and still are obese my stipulation was I had to be at least 100lbs over weight I was 179lbs over .

it seems like it will never happen but it will and you will be so happy

dont ever give up be very persistent I started mine in September and finally happened in May thanks to my Doctors they really do care:thumbup:

[KayleighsMommy 16]

Thats not as bad as it sounds .My surgery was may 15 th and it seemed like it was never going to happen, I had to come up with 5 years of medically

supervised diet .I was a Medicare patient with COPD and a BMI of 48 .

Call your primary care and ask him to help you he just put notes on his letter head with dates of my visits and my weight for 2 years thats all they are looking for showing that you were and still are obese my stipulation was I had to be at least 100lbs over weight I was 179lbs over .

it seems like it will never happen but it will and you will be so happy

dont ever give up be very persistent I started mine in September and finally happened in May thanks to my Doctors they really do care:thumbup:

They already got my 5 years of medical records (I have been overweight for 40 of my 46 years) It has to be a documented diet...Jenny Craig, Weight Watchers, whatever...but it has to be fully documented. I do not have this.

[KayleighsMommy 16]

Is the 24 months medically supervised weightloss a requirement of your surgeon on the insurance company?

The insurance company... can ya believe it??? It went from "oh, yes, she is completely covered..no prerequisites or co pays" to... "we need 5 years medical documentation, as well as the sleep apnea study" (done), to " she needs 24 months documented diet" The insurance girl in the doctors office absolutley cannot believe this bull.

[KayleighsMommy 16]

24 Months Medically Supervised Diet Is Not For Your Health - It's For Their Bottom Line. It's Just A Way Of Putting Up A Gigantic, Basically Insurmountable Roadblock So That You Don't Send Them The Bill, And End Up Paying For It Yourself. It's One Thing If They Just Don't Cover It Because The Policy Excludes It; It's Another If It Purports To Cover It But Makes It Impossible To Ever Get It.

Honestly, Our Health Care System Is So Incredibly Screwed Up, It Makes Me Sad For The Future Of Our Country. I Read An Article In The New York Times The Other Day About How Many Doctors Are Quitting Medicine Because They Don't Get To Actually Practice Medicine Anymore; It's All Paperwork And Bureaucracy. I'm Very Lucky To Have Insurance That Covers Lap-band Without Many Hoops To Jump Through (no Supervised Diet Requirement At All), But It's Just That - Pure Luck. Access To Health Care Should Not Be Governed By Luck.

Amen To That.....

[Phoenixrising 0]

I have heard that Cigna was going to start requiring this but I hoped it was just an ugly rumor. I agree it is just another road block they are putting out there. I don't know which is worse, saying they will cover it and then making in impossible to meet the criteria or just excluding all WLS of any kind which is the policy my employer has with Cigna.

[Shinyhappymommy 2]

KM,

So sorry! I'm glad you're going through with the surgery though. Keep me posted on how it goes. Call me if you'd like.

Melissa

[Nouli 0]

I am not banded but working on it. We have BCBS through the Carpenters Union. I contacted the union office 2 weeks ago and asked them if the Lap Band was covered. The rep said yes, I need a letter sent from my doctor to the union which they turn the file over to Magellan Health Services, a third party, then they approve or deny. I asked if it's approved what next? I was informed that I would receive a letter and then schedule my surgery with the surgeon. WOW that was easy!

Called again yesterday to ask a question and was told by a different rep that Lap Band is not covered only Bypass. Don't know what to do now.

Where are you having the surgery for $5500.00?

[nazzy 1]

u didnt have to do tests?see nutrinust?or physcho evel?

[Nouli 0]

I wasn't told about any of the tests you mentioned and I haven't done anything yet. I just called the Union office to see if it was covered and what the procedure was. One rep told me one thing another told me different.

I am exploring options at this point and curious how much self pay would be here in Chicago if my ins. turns me down.