BCBS MN Doesn't cover...Now What??

[Kasie 4]

I am in a bad place today I have done all my requirements, 6 months of the required diet, just to find out today that BCBS of MN still isn't covering the sleeve..unless you have serious other issues (which I don't, I am only morbidly obese). So now I am stuck, I was hoping that while doing the 6 month diet, that BCBS would switch their policy, but no such luck. I am torn between switching back to the RNY, (even though I really want the sleeve) because insurance will pay for it, and the other option I have is Self-Pay, which is $20,000

I am so frustrated! Crying all day! The Husband says put it in the budget, so yes in about 2 years, we could pay for it, and I am grateful that he says that, but I want it now, I have already been jumping hoopes for a year! I just feel beat down.

[Hopeful24 1]

bcbs of mn???

[EmilyIsSleeved 6]

I am in a bad place today I have done all my requirements, 6 months of the required diet, just to find out today that BCBS of MN still isn't covering the sleeve..unless you have serious other issues (which I don't, I am only morbidly obese). So now I am stuck, I was hoping that while doing the 6 month diet, that BCBS would switch their policy, but no such luck. I am torn between switching back to the RNY, (even though I really want the sleeve) because insurance will pay for it, and the other option I have is Self-Pay, which is $20,000

I am so frustrated! Crying all day! The Husband says put it in the budget, so yes in about 2 years, we could pay for it, and I am grateful that he says that, but I want it now, I have already been jumping hoopes for a year! I just feel beat down.

I would definitely appeal it. My information is being submitted tomorrow to BCBS of MN (about time, seems like I have been waiting forever) and I know they will deny on the first time around because like you, I don't really have any other problems except for being morbidly obese. However, I talked to the insurance lady at my surgeon's office and she said that even if they deny me the first time around, I need to keep appealing because she thinks by this summer BCBS of MN will change their policy just based on how quickly other policies are changing. She said that other BCBS policies nationwide are changing, so it is only a matter of time before MN changes theirs. You won't lose anything by trying to fight back through an appeal. It is worth a shot.

Good Luck!

[iegal 460]

Couple of ideas:

1) BCBS of IL covers it...as of Nov 2010. Is is possible for you to buy insurance from them, get a transfered policy and self pay insurance for a 6+ months and then get sleeve? This might be cheaper than shelling out $20K.

2) Appeal and ask why other BCBS agencies are covering but not MN

3) Remember you must have BMI of 35 with 2 comorbidities or BMI of 40 with no comorbidities for BCBS

Good luck and keep us posted

[Kasie 4]

You guys are so great! I don't know what people do that haven't found this forum yet? I am going to try to appeal, and maybe even appeal again. I am also going to look into the BCBS IL -- great ideas! Thanks so much!

[Royaltykay1 0]

I am in a bad place today I have done all my requirements, 6 months of the required diet, just to find out today that BCBS of MN still isn't covering the sleeve..unless you have serious other issues (which I don't, I am only morbidly obese). So now I am stuck, I was hoping that while doing the 6 month diet, that BCBS would switch their policy, but no such luck. I am torn between switching back to the RNY, (even though I really want the sleeve) because insurance will pay for it, and the other option I have is Self-Pay, which is $20,000

I am so frustrated! Crying all day! The Husband says put it in the budget, so yes in about 2 years, we could pay for it, and I am grateful that he says that, but I want it now, I have already been jumping hoopes for a year! I just feel beat down.

Hang in there Kasie! God's timing is perfect...there may some other reason you can't have it right now but pray and just try and find peace today...that's all we have is "TODAY"! I can only imagine how disappointed you must be ...but I know the answer will become clear soon! just trust that God is working behind the scenes for you and will help you through this tough time! I'll pray for you today!!

[Eureka-C 20]

I didn't think I had any comorbidities either, then when the doc's office did my eval, they pointed out the edema in my ankles (socks leaving grooves on a daily basis), some incontinence when sneezing or coughing, sores that develop under my fat roll along my c-section scar, acid reflux, low Iron, and a family history of diabetes. I also had a lot of knee pain, and a knot on top of my foot due to being overweight. Others find out they have sleep apnea, prediabetes, high blood pressure, hypothyroidism, GERD etc. Talk to the nurse and find out a list of problems. Most I just took for granted, tolerated or ignored them and went on with my life, but they made a big difference in my appeal I believe.