I need some Help please!

[southernbanded 4]

Hi all I my name is Lisa from Louisiana I am 34 years old and currently 297 pounds. This is a great site looks like a lot of great people are on here who are willing to help others that is awesome! I am in need of some help. I am wanting to get the vertical sleeve and I have BCBC of Louisiana with the state and it is not covered. I have not been to the doctor because I know that the insurance will not cover me. What steps do I need to take to see if I can get an approval? I have heard of appeal letters, but I have not sent in a claim since I have not been to the Doctor. What steps do I need to take? All your help is greatly appreciated!:tongue_smilie:

[feedyoureye 3,087]

I would go into your Dr. and ask him/her. I was at my Dr's for something else and asked if she could give me a referral to a Bariatric Center in the same medical system. Perhaps the Bariatric Dr. or the patient liaison in his staff can tell you if your insurance has approved the surgery for anyone else. I would think if the Bariatric surgeon thinks you have a case he might put in an appeal?

I'm just guessing here... anyone out there from Louisiana?

[JC76 0]

I work for Texas A&M here in Texas and my BCBS cover's it. It has just started so you may want to check again just to be sure. I don't know why the state you are in would make a difference.

[goodlife 3]

I have BCBS of Louisiana and it's an exclusion on my policy. Not just VSG but ALL weight loss surgeries are exclusions. No appeal possible. I self paid for my VSG and it was worth every penny.

So...you need to find out if they cover WLS but just not the sleeve or if WLS is an exclusion altogether. If they do cover WLS but just not the sleeve, you have a good chance of winning that with an appeal. If it's excluded, then your only option is to self pay.

[M2G 1,836]

Insurance rules change every year, so it may not be covered this year, but maybe next year? I don't know if they would tell you what is coming up for the next calendar year, but that might be an option, to call and find out what will be covered next year.

Every self-pay patient that I have talked to says the same thing "it is worth every cent!"

[southernbanded 4]

thanks so much for all your help I will take everyones advice! is it easy to get a medical loan for surgery?

[wannalise 16]

Yes, it is very doable to get financing, shop around. My fave option and the one I ultimately went with was medchoice. I know that surgery loans also does financing. Some surgeons have their own financing programs in place, and many of the loan providers require that the surgeon you are going with is one of their providers. Good luck!

Anna

[bchrist 0]

What part of Louisiana are you in? I'm from the Baton Rouge/Prairieville area. My insurance did not cover WLS either, so I was self pay and also got a small loan from Iberia Bank. They were recommended from my doctor's office. Good luck! I am 2 weeks postop and have already lost 18 pounds. It is an easy surgery and recovery.

[coreyandbrett 0]

I don't know how easy a medical loan is, but I've noticed several on here have went to a doctor in Mexico for the surgery. It is almost as cheap as my co-pay was. I went and looked at their website and it's a really nice center. If your money is tight, you might want to consider that. Just get on here and read what some of the ones that went Mexico have written and check it out closely before making a decision.

[Big_Mike 0]

It's ridiculous that it would not be covered. I would contact your family attorney to refer you to an attorney who would address this. Consultations can be free. Contact your state medical board to find out why BCBS does not pay. Here in Connecticut, my BMI was 35 and I was covered by CIGNA for whatever procedure I wanted, RY, sleeve, or lap band.

Please consider the legal challenge first.

[southernbanded 4]

thanks to all of you! I just talked to my Dr. office and BCBS of Louisiana through the state does not pay for the surgery and they said that they hardly ever approve an appeal so I guess my only option is self-pay. so sad I pay so for insurance coverage and they will not cover me ; (

[Big_Mike 0]

I still think a few phone calls are worth it. It sounds like a cut and dried legal issue. This has been litigated in Rhode Island, Florida, and other states. It's a slam dunk for an attorney. Stay with the state agencies before going to an attorney.

At the least, you may find out that it will be covered January 1st, 2011.

[southernbanded 4]

Thanks mike I will make a few calls!