BCBS of TN Questions - Please Help

Roxstar · August 14, 2008

Hi! I have some questions about BCBS of TN.

First, has anyone successfully gotten WLS procedures approved through BCBS of TN?

Can anyone provide any more information about the 'hoops' they had to jump through to do so?

My doctor suggested trying WLS a couple of years ago, but I kind of just shrugged it off thinking that I could do it myself. I don't think I can. I've tried and I'm turning 27 this year and I want to have kids in a couple of years. I know that I won't be able to have kids like this. I don't want to live my life like this anymore. I haven't been happy for a long time and watching people be so successful with WLS and other methods just really makes me realize even more than I don't HAVE to be this way.

Anyway, I don't have any blood pressure or diabetes or anything like that. My doctor says I'm healthy, just overweight. I DO believe I have sleep apnea, however. I was sent to a sleep doctor a couple of years back and he thought so too and wanted me to do the testing. I never did it, but I know I need to as I probably do have it. I snore a lot, a lot, a lot and I am very loud.

I know my BMI is probably over 50 now, if not - it is definitely over 40. I haven't weighed in months.

I have severe back problems where I am in pain a lot. Every so often I get to the point where I have to visit the doctor and he gives me some medication, a shot, etc. I guess it is pain management in some form, but it is sucky pain management. I want to be FREE from pain and I know my weight contributes to it.

Please help. Please, please, please.

Thank you.

ccarter8219 · August 14, 2008

Hello, I am a review nurse for an insurance company. I have a couple of questions for you. 1 - What type of coverage do you have (HMO, PPO, etc.) & 2 - Does your group have an exclusion for WLS?

If your group has an exclusion then they are rarely approved on an appeal. If your group is a self funded group, you can sometimes appeal to the group administrator to have the exclusion lifted.

Let me know if you have any questions. I hope I can help. Crystal Carter, RN:rolleyes2:

Roxstar · August 15, 2008

Sorry I didn't get a chance to reply yesterday - had a busy day.

Thank you for responding to me. I appreciate it.

I don't know if my group has an exclusion to the WLS. How can I tell? Also, yesterday we found out that my husband may be switching jobs and if he does, he will have CIGNA coverage. Is one more likely to approve than the other?

The BCBS of TN is PPO coverage.

Thanks for any help you can provide.

ccarter8219 · August 15, 2008

To find out whether or not it is a covered benefit or an exclusion, you can call the customer service number on the back of the card. Let them know you are interested in Lap-Band WLS, and they will tell you if it is included or excluded. PPO coverage seems to be better than HMO, but you can never tell.

I am not sure about cigna, you would have to call their customer service number to see if it is or is not eligible (just like blue cross). You would need to know what group he is looking to join when he takes his new job.

I hope all works out. Let me know if you have any other questions.

Crystal Carter, RN:biggrin: