I'm trying to appeal to BCBS of Oklahoma for the lap band & am interested in BCBS's coverage of it in other states...anybody out there know???

PS: Anyone else having BCBS issues? I'm curious.

I will be starting my BCBS trip sometime this week when the dr submits all of my paper work. They cover it, however my company doesn't. However, 7 other people at work appealed and won and are now all 100+ pounds lighter.. so here I go.

Superglueing my fingers in a crossed postion

Tracy

I will be starting my BCBS trip sometime this week when the dr submits all of my paper work. They cover it, however my company doesn't. However, 7 other people at work appealed and won and are now all 100+ pounds lighter.. so here I go.

Superglueing my fingers in a crossed postion

Tracy

Best of luck to you Tracy. I wish I had someone at my work that was encountering the same situation.

Keep an updated post here so I can follow your journey.

If the table won't hold anyone that heavy how are they going to do GBP? There are several super morbidly obese people here that have the band. Some started with BMI's of well over 50. ~Mandy

I was speaking in reference to the hospital I am working with. There are several places that do patients much heavier. This would not apply to those facilities.

Best of luck to you Tracy. I wish I had someone at my work that was encountering the same situation.

Keep an updated post here so I can follow your journey.

Whatever you or anyone else here does that is denied. DO NOT GIVE UP> Fight like your life depends on it. well.. cause IT DOES!

Tracy

Great Letter!!!!!!!!!!

PS: Anyone else having BCBS issues? I'm curious.

I fought them in 2005, it took me 3 appeals and just before we were going to outside appeals, they approved me. I got my husbands Union involved, that helped I'm sure. ~Mandy

I fought them in 2005, it took me 3 appeals and just before we were going to outside appeals, they approved me. I got my husbands Union involved, that helped I'm sure. ~Mandy

What was the basis of their denial? Not covered?

I am at Level II right now. After this we go to the state level, I'm fine with fighting for this because I believe in change and fighting for change. I just want to leave a nice trail on my way up this mess hoping to CHANGE this system for all the others who accept the "No".

What state are you in Mandy?

I am in IL but have Highmark through NJ. I was told my walter lindstrom that highmark is tough to beat. THey denied it and called it experimental. It was an exclusion on my policy. I fought and won because I had the option of BCBS or United Health Care through my hubby's employer (Union Pacific railroad). United Health care covered it and bcbs didn't, the union is under a nationally negotiated contract and the law says coverage has to be fair and even for all employees. I complained to the union and they got involved and I know of at least 3 others with highmark that have been covered. When I started the appeal I was told that a snowball had a better chance in hell then I did for coverage. 6 months later I was having surgery. It was covered 100% and all of my fills are covered also. It is possible to fight and win...don't give up, there is hope. ~Mandy

I am in IL but have Highmark through NJ. I was told my walter lindstrom that highmark is tough to beat. THey denied it and called it experimental. It was an exclusion on my policy. I fought and won because I had the option of BCBS or United Health Care through my hubby's employer (Union Pacific railroad). United Health care covered it and bcbs didn't, the union is under a nationally negotiated contract and the law says coverage has to be fair and even for all employees. I complained to the union and they got involved and I know of at least 3 others with highmark that have been covered. When I started the appeal I was told that a snowball had a better chance in hell then I did for coverage. 6 months later I was having surgery. It was covered 100% and all of my fills are covered also. It is possible to fight and win...don't give up, there is hope. ~Mandy

Thanks Mandy. I have BCBS of FL which has a specific clause in our contract that states it does not cover weightloss surgery. In fact, it went into a full paragraph about not covering any type of nutritional classes which actually made me sick as I read it. Think: So let us get fat, heart attacks, strokes, and diabetes and you still won't pay for educating us or providing surgical rememdy??? That is one of my beefs that they went so indepth as to write exactly what to exclude but not what to include to maintain a healthy lifestyle if you are overweight and nothing is working (as if there aren't us out there in the population). It screamed of discrimination to me, honestly.

I sent that appeals letter in today. I sent the pictures yesterday. I also sent a quick email tonight for the name of the state agency we go to next for the third level of appeals from my contact at BCBS.

**Mindful thought: These people are only doing their job. They are people just like us and if they have to read the NO word I'm sure it isn't making their day. One individual confided if it was up to her she would approve it as her best friend was over 400 pounds and died waiting for approval for this surgery.**

I am very confused. Iwas just denired lap Band surgery by BCBS because my BMI was over 50 . They would approve Gastric bypass but I would need to get my BMI down to 40 to have the Band approved does this sound right to you guys? :help:

Hey John -

Been there, done that, won the insurance battle.

e-mail me and I will forward the letters I used to fight.

Hugs and good luck~!!

for those with FED BCBS, what is the wait time once the insurance is submitted??? thanks

I have BCBS of Texas and they have just approved lap band through the federal health plan on the PPO side. One catch is that they have to be over the 40 BMI in order to have it done or under 40 but have one or more co-morbidities. I am only at 37 BMI (but 100 lbs overweight) and don't have any co-morbidities to speak of..... Any suggestions?

Kindred--I am in OK and have BCBS of Oklahoma and they told me that in Oklahoma they don't pay for but federal BCBS does and other states do. So I guess BCBS of OK is sucky! I appealled once, got denied and then just paid for it myself. But perhaps if you fight harder than I did you will get it.

Margo.. I would do a search for uncommon co-morbidities...

I read somewhere.. and I can't remember where.. but things like

Infertility, PCOS, Skintags, BackPain, Heartburn GERD.. and things like that are also considered....