Blue Cross of Florida just crushed my dreams

[stuart85 28]

Hello, I've been going through the process since early January, the nurse called BCBS of FL to see if it was on my policy on day one, they told her it was, I went through everything for it, they submitted for final approval and BCBS said it's not covered, apparently Bariatrics under a single person Obama policy is excluded, even the Platinum coverage which I currently pay $450 a month for, my question is has anybody recently had success with BCBS of Florida and/or what plan do you have in Florida that covered it.

Thank you very much for your help

Stuart

[gigito2 52]

I'm so sorry, Stuart!

I don't have any experience with this, but I have read on these boards that initial rejections were reversed after a call to the ins co by your surgeon. Maybe it will work in your case.

I've also heard that it can sometimes come down to who you talk with at the ins co - which would make sense since the original person said it was covered. Perhaps another call or two will make the difference.

I'm keeping my fingers crossed for you!

[stuart85 28]

I'm so sorry, Stuart!

I don't have any experience with this, but I have read on these boards that initial rejections were reversed after a call to the ins co by your surgeon. Maybe it will work in your case.

I've also heard that it can sometimes come down to who you talk with at the ins co - which would make sense since the original person said it was covered. Perhaps another call or two will make the difference.

I'm keeping my fingers crossed for you!

I'ver personally harassed them three times, the doctors office has tried calling their special phone number but it's so busy after over an hour trying nobody ever came on the line, my folks even went to their office and sat on hold for the nurse because she couldn't wait. The letter of rejection hasn't shown up when it was denied two/three weeks ago.

Thanks for the advice . . .

[gigito2 52]

I'm so sorry!

[Sharpie 3,306]

I have bc/bs of fla. but it's a medicare supplement and my surgery was paid for by them and medicare but that was before Obamacare became the law of the land. I have heard from others that had to go on it that they cannot get bariatric surgery but I'm not sure if that is the case all over. Insurance companies love it because they can just collect money each month and exclude things they don't want you to have. I hope you can get it resolved .

[stuart85 28]

I have bc/bs of fla. but it's a medicare supplement and my surgery was paid for by them and medicare but that was before Obamacare became the law of the land. I have heard from others that had to go on it that they cannot get bariatric surgery but I'm not sure if that is the case all over. Insurance companies love it because they can just collect money each month and exclude things they don't want you to have. I hope you can get it resolved .

Thanks ... it's incredible they are willing to pay for multiple heart attacks, diabetes and any other possible issues I could have as well as medication, yet not let me have one surgery that could change all of that

[Nikasio 59]

Affordable Care Act weight loss surgery guidelines require insurance companies to provide coverage for all individual, family and Small Group plans (plans with 50 or fewer full-time employees) only in states where bariatric surgery can be called an "Essential Health Benefit". So basically, the state of Florida does not consider it to be an essential health benefit, so the affordable care act does not cover it. So they will pay for counseling, medication, and the complications of the comorbidities, but not necessarily the bariatric surgeries. You might want to re-check with your surgeon because some states just have high requirements for BMI and the need for several comorbidities like diabetes, hypertension, hyperlipidemia, etc. But from what you are saying, you already discussed it with them.

[stuart85 28]

Affordable Care Act weight loss surgery guidelines require insurance companies to provide coverage for all individual, family and Small Group plans (plans with 50 or fewer full-time employees) only in states where bariatric surgery can be called an "Essential Health Benefit". So basically, the state of Florida does not consider it to be an essential health benefit, so the affordable care act does not cover it. So they will pay for counseling, medication, and the complications of the comorbidities, but not necessarily the bariatric surgeries. You might want to re-check with your surgeon because some states just have high requirements for BMI and the need for several comorbidities like diabetes, hypertension, hyperlipidemia, etc. But from what you are saying, you already discussed it with them.

That's interesting, what if the surgeon isn't in Florida but in NY where it is easily available to get the surgery?

Thanks!

[scstxrn 213]

@ Stuart85,

It is all in where you live (and buy your insurance).

It wasn't covered on my policy, either.. I saw dr. Ponce de leon in Tijuana Mexico and financed the 5k for my surgery and travel. I'm paying it off at 300 a month for two years, and if it weren't for all the extra shopping I'm having to do 'cause my clothes won't shrink, I'd be saving enough on my food bill to cover it.

[LousPeachy 100]

I am so very sorry. And don't EVEN get me going on the so called Affordable Care Act.

I am in Texas. Medicare pays for surgery and my AARP supplemental insurance picks up the rest as long as Medicare covers some of it. I think it is beyond stupid not to cover surgery if it is medically necessary. I will be praying things can be worked out for you.

BTW, is that dollar amount you mentioned what you pay through the ACA? If so, all I can say is Yikes!

[amsaf 16]

I have obamacare Florida Blue (BCBS) they specifically exclude WLS im sorry i was very dissapointed too we tried to go the medically necessary route but they wont cover it no matter how you try. Now its cash pay

[sharonintx 1,275]

Go to Mexico. it doesn't cost that much. Heck, the lower food bills alone would pay for the surgery in a relatively short time.

[jane13 2,256]

@@sharonintx is right - the food bill will drop and you could probably afford it if you can get it financed. Good luck. I live in Florida and have BCBS federal employee and it was covered. No issues.

[KristenVSG2014 1,871]

I have BCBS through my employer but they excluded WLS specifically so I went to Mexico. $4,500. I financed it for 3 years. $140 a month. Best decision ever.

By the way, I feel your pain. My husband has the platinum plan with BCBS and its $380 a month. Geez. I could be driving a new car for that!!

[yagoubi26 10]

Just curious, did you actually look at your benefit plan before going through all that? I knew my insurance coverage before I even started.