BCBS Cruel Game

[Sluggo 0]

With a long history of diets and yo-yo loss/weight gains, now BCBS wants me to do it again for 6 months by their stringent rules. Then if you succeed, and I know I will, to fall below the qualifying BMI, you do not get approval. You repeat the same cycle gaining it back later on. A person would be better off to fail at the diet for 6 months. BCBS would rather pay years and ultimately high amounts towards claims related to the serious consequences of obesity than help a customer with a courageous decision to seek a surgical weight loss alternative. That doesn’t even make good business sense. Of course it does if you die - they win.

[wacogurl 0]

Is that what they told you? If your BMI is lower from losing weight they wont pay? Or is that what you are assuming... I just talked to my BCBS yesterday and they didnt tell me that... but my BMI is 43 so even if I do lose I will still fall in that category. I have read on here that the insurance still covers it... they just do it to make sure that you can follow a diet... they dont want to pay for you to get it and then you not keep up with your end of the deal... I hope that made sense... but please tell me if that is what the insurance has told you. It will all work out for you in the end! Good Luck!

[RestlessMonkey 7]

Believe it or not a good percentage of people, when forced to do the 6 month diet, have success and decide that they "can", after all, do it on their own. Some insurance companies are notorious for the hoops they require their customers to jump through. Just do it; mark the time, consider its cheaper than paying for it out of pocket. You'll be 6 months older whether you do it or not; this way you also won't have 15-20k in debt.

[Loveslady 0]

With a long history of diets and yo-yo loss/weight gains, now BCBS wants me to do it again for 6 months by their stringent rules. Then if you succeed, and I know I will, to fall below the qualifying BMI, you do not get approval. You repeat the same cycle gaining it back later on. A person would be better off to fail at the diet for 6 months. BCBS would rather pay years and ultimately high amounts towards claims related to the serious consequences of obesity than help a customer with a courageous decision to seek a surgical weight loss alternative. That doesn’t even make good business sense. Of course it does if you die - they win.

Are you sure?? During my process, it had to be for 6 months. I went to the doctor every month. took some nutritional classes (20 mins). My doctor basically said to follow nutritional guidelines and DON'T GAIN WEIGHT. So I'm wondering if your process of 6 months is the same as my 6 months of "dieting". During the 6 mths I only loss 5 pounds. It's all about paper work make sure you say you are following all guidelines. the 6 months helps you get used to things that may be given up.

[PMOSS 0]

I have bcbs also and yes it is true or at least with my plan that if I go below 40 bmi on the 6 month diet it will not pay they will "encourage" you to continue the diet you are on and no lap band.

[LarraineM 6]

This is what Health Care Reform is all about.BCBS is my insurer also.In fact I have two Health care policies one from my employer and one from my husbands employer.My family has been covered for over 25 yrs but I still have the same hurrdels to jump.I hate haveing them with me when I go to my doctor.I d trust the public option anyday.I finished my 6 months last month but their argument was that it did not happen over 160 days period as opposed to 6 visits with my primary. So they made me wait an additional 3 wks to get their number right.! I was finnally approved today only after one more hoop.My thoughts are they were betting I d drop dead or give up! A fat woman determined go figure,They did'nt get to collect.Hang in theredo what they want and GET WHAT YOU WANT!!!!!!!!!!!!! good luck

[RestlessMonkey 7]

This is what Health Care Reform is all about.BCBS is my insurer also.In fact I have two Health care policies one from my employer and one from my husbands employer.My family has been covered for over 25 yrs but I still have the same hurrdels to jump.I hate haveing them with me when I go to my doctor.I d trust the public option anyday.I finished my 6 months last month but their argument was that it did not happen over 160 days period as opposed to 6 visits with my primary. So they made me wait an additional 3 wks to get their number right.! I was finnally approved today only after one more hoop.My thoughts are they were betting I d drop dead or give up! A fat woman determined go figure,They did'nt get to collect.Hang in theredo what they want and GET WHAT YOU WANT!!!!!!!!!!!!! good luck

You do realize that employers, at least so far, have a choice in purchasing insurance for their employees? And that not all major insurers require that 6 month wait? And that if your employer wanted to, it could purchase different coverage that did NOT have that stipulation?

[feelnew2 0]

Hi everyone, I have BCBS of Georgia and I did not have to do a 6 month diet and my bmi is around 45. I had my paperwork submitted on about Aug 11th or so and I was notified of my approval on about Aug 27th. I am scheduled for my surgery on Oct 08. So, maybe it does have something to do with your employer. Not sure...

[thinoneday 445]

With a long history of diets and yo-yo loss/weight gains, now BCBS wants me to do it again for 6 months by their stringent rules. Then if you succeed, and I know I will, to fall below the qualifying BMI, you do not get approval. You repeat the same cycle gaining it back later on. A person would be better off to fail at the diet for 6 months. BCBS would rather pay years and ultimately high amounts towards claims related to the serious consequences of obesity than help a customer with a courageous decision to seek a surgical weight loss alternative. That doesn’t even make good business sense. Of course it does if you die - they win.

Isn't it cruel how they are. . . first the doctors and insurance companies complain how obese America has become and how something must be done now. . . then when we try to help ourselves with the band, RNY, sleeve, or something they are the first to say "oh no, you have to do it this way and that way" Good Lord, they hold your life in their hand and they know it. . . very cruel and mean. . . PS: I love the doctor who sits in front of us and preaches how fat we are and how we should lose weight blah blah blah, and all the time he is the fattest thing a person has ever seen!

Edited September 16, 2009 by Erykah

[Big Ed 0]

I have BCBS through my employer and I know it takes 6months of Dr. sup. diet. because my wife had the band two years ago. but beware that health plans can change at anytime for most. It has everything to do with your employer. My benefits rep's first reply when I asked about WLS was that its NOT covered!! then told me it takes 12months of Sup. Diet and I had to have several comorbidities. that wouldn't be so bad but my PCP is lame and just treats me as another piece of meat that needs to get out of his office within 5mins and pay up. I wonder if he doesnt' want to keep me Fat for Job security????

[thinoneday 445]

I have BCBS through my employer and I know it takes 6months of Dr. sup. diet. because my wife had the band two years ago. but beware that health plans can change at anytime for most. It has everything to do with your employer. My benefits rep's first reply when I asked about WLS was that its NOT covered!! then told me it takes 12months of Sup. Diet and I had to have several comorbidities. that wouldn't be so bad but my PCP is lame and just treats me as another piece of meat that needs to get out of his office within 5mins and pay up. I wonder if he doesnt' want to keep me Fat for Job security????

HI Ed, yes sometimes I wonder that myself. . .not only for job security, but also to say "well I talked to another statistic today" I really don't have much nice things to say about some physicians, and like i posted on another thread just now, I've worked with tons of physicians in alot of different areas of the medical field and even though the majority of them are good, there are quite a few which can be truly labeled "pumpas asses". . . they are such errogant idiots. . . have you been banded yet? Have you ever thought of maybe going through self pay? I'm going that route and got a great loan through my bank for the whole amount at 3% interest. . . can't get any better than that. . . just a thought.

[ParrotheadCathy 0]

And I have BCBS of Georgia and my policy has a written exclusion regarding ALL weight loss surgeries. Every employer negotiates their policy based on what they are willing to pay and getting the best coverage for the amount they are willing to spend.

So, your policy requires the 6 month supervised diet. You don't HAVE to lose a significant amount of weight to be approved. Like the poster who said she lost a total of 5 pounds in the six months. During the six months, you can do all the pre-op testing they require (nutritional visit(s), psych evaluation and as you get closer to surgery, sleep study, upper GI, the blood work whatever. Then, at the end of the 6 months, your package is submitted with everything all ready to send in and surgery shouldn't be too much further in the future at that point.

Yeah, I understand not wanting to wait but that's the way it is. Your alternative is to self-pay the whole cost and you can probably have surgery within 4-6 weeks.

Your choice, but $$ is a big factor.

[luluc 6]

i'm not fond of BCBS & yes i found them to be cruel.

before even meeting w/our surgeon, DH and i got a copy of our policy.

it specifically COVERED WLS - no 6 month diet but the criteria was simple:

BMI over 40 w/1 comorbid

BMI under 40 w/2 comorbids

i didn't qualify, but tried anyway - denied next day.

my husband however, had a BMI of 42, HBP/sleep apnea/High Cholest./borderline type 2 Diabetes.

BECAUSE he was on NO medication - BCBS denied him. while on the phone w/them, i asked them specifically where that is noted in my policy......not even a "fine print" existed.

i told them that making decisions on the fly was pretty unethical & hung up.

we didn't even try to appeal & went self pay right away.

the first chance we had to drop them in the next open enrollment we did & very happy w/current plan.

current plan has covered every test / office visit / fill / 2 endoscopes / hernia repair etc.

so - not a fan & can understand your frustration.

[frauhowe 1]

I have bcbs also and yes it is true or at least with my plan that if I go below 40 bmi on the 6 month diet it will not pay they will "encourage" you to continue the diet you are on and no lap band.:tt1:

Same with mine. I'm told by someone else with the same plan as mine that if you lose enough to drop below 40 you're basically told "continue on your current successful weight loss regimen." (hey you, stupid blue cross lady…it’s only successful if it’s PERMANENT!!!)

I’m officially one week into the 6 month diet. So I have to lose SOME weight, but not TOO much or I’ll disqualify myself. At a bmi that hovers around 42 I'm walking a fine line here.

On the plus side…at my first appointment last week my blood pressure was up for the first time ever. A-HA, the beginnings of my first comorbidity? (listen to me…I’m actually “pleased” to get a comorbidity, anything that will help the chance of approval. How sick is that!? This is what the insurance company has made be become).

Don’t get me wrong. I don’t deliberately want to sabotage my efforts, it’s just that everyone knows what the odds are of a person gaining it back, so I’m not overly confident that this diet will be any different from any other. I’ve been yo-yoing for years, I’ve had plenty of experience at being a fat chick. But the insurance company thinks they know me better than I do. If I could do it on my own, I would have done it a long time ago. I was always under the impression that yo-yoing is more unhealthy than a slow steady climb.

[LarraineM 6]

You do realize that employers, at least so far, have a choice in purchasing insurance for their employees? And that not all major insurers require that 6 month wait? And that if your employer wanted to, it could purchase different coverage that did NOT have that stipulation?

If you viewed the President Health Care speech last wednesday you might have caught a known fact here in Alabama,BCBS carries 98 % of all employers. Not much choice avaiable here:thumbdown: