well, i went home and found my bcbs benefit book and found out what the customer service rep. told me was true. #20 states...the plan covers and will not pay services intended to treat obesity, such as gastric bypasses and balloons, stomach stapling and jaw wiring. i just knew that couldn't be true. but it's in black and white. so, is that that? can i appeal? am i able to appeal? or do i just give up the idea of getting this procedure through my insurance carrier. i'm hoping with my medical problems that i explained in my introduction earlier today, and maybe with the help of a concerned doctor/doctors i might be able to get it. what do you all think. is this iron clad or can i protest with an appeal. if i can't, i can't. thanks for listening.

I have bcbs in Michigan (MESSA - most teachers have it) and I will be covered 100%! It is amazing to me that companies called bcbs are not all the same...keep trying. You might try getting your dr.'s office to help you. GOOD LUCK and don't give up!

Please keep in mind that if your insurance is through your workplace that it is probably not the insurance company that decided not to cover this but that your employer decided not to pay for this to be a covered service. Companies may chose to have exclusions, things that they exclude from coverage, usually in an attemt to keep the cost of health coverage as low as possible. Smaller companies are more prone to do this from my experience due to their obvious need to pennypinch. One option is to go talk to the powers that be at your employer and request that they change this when the policy is up for renewal, most likely in January.

And no, there is no point in appealing. This is not a matter that they have decided that in their estimation you do not meet the requirements...this is a matter that you could have the highest BMI on earth with every comorbidity known to man and you would still not be covered for the proceedure.

We will be paying for it by taking out a home equity loan.

The Same With Me , I Have Bcbs They Have Started Coving The Lapband Surg,however The Doctor That Will Perform The Surg Will Not See Until All Your Paperwork ,such As Doctors Clearance, Heart Doctor Clearance ,monit. 6month Diet ,psy Clearance And Dietary Clearance.so Much Without Any Help. I Am In Atlanta Ga,doctor Is Peachtree Batri.surg.any Atl Ga Bandster Out There?

you mean business! i agree money doesnt love you or keep you warm and i am in awe of your decision... you have your priorities in the correct order... i wish u the very best...vamaillady

I have BCBS.......... but no matter the insurance company it is YOUR EMPLOYER that either allows it to be covered or not.......... mine did... it had to be approved....... I had to have a psyc eval and a nutritionist eval. Both had to submit letters to my surgeon. BMI between 35-50.

All the 'blues' are actually different companies... find out from your employer if WLS is covered even if you see the words "medically necessary" that means it IS covered.

Hello,

My insurance company wouldn't help with my surgary or anything else to do with obesity. But, obesity is recognized by the IRS so I was able to get a tax break by using my flex spend account for surgery.

Good luck to you.

Connie

GREAT POINT! I did load my FSA card with my OUT OF POCKET MAX! it has worked beatifully!

Before getting your hopes up or shot down, pick up the phone and call your insurer, and talk to them. BCBS has many states they have different coverage in, and has been pointed out, many exclusions are due to the employer package bought as opposed to the insurer themselves. The information in my BCBS of TX book was NOT the same info given to me over the phone, and that was actually required for them to cover the surgery.

Now dealing with BCBS of TX was a nightmare! I was 10 1/2 months into a 12 month medically supervised diet when I was involved in a car accident. They said I missed a dietician appointment (was being done through my pcp), and his coming to see me in the hospital did not count, that was medical. So they were going to make me start the 12 months over, insisting it had to be done consecutively. There was no discussion, even with the appeal, it was very plain---do 12 months consecutively and follow the other requirements and we will pay, but not until. BUT even if I had done the next 12 months, they would not cover another sleep study for 2 years...several things would have had to be redone, and been OOP...in the end, the insurance of the car that hit me made me a cash settlement, and I went to MX to a surgeon I researched very well. I could not be happier.

IF ever my DH's employer offers another insurance, we will jump ship so fast, the dang thing may capsize!!!

One other thing, when you call them, take detailed notes, of who you talked to and when you talked. Note how many people you were transferred through, and how long you were on hold. And write down exactly what they tell you. Because if your experience is anything like mine, you will get a conflicting story each time you call! Being able to recall who said what when will be invaluable. It is also nice to take to your employer if it is them excluding weight loss, and let them know just how well the company they pay is working for them...or not.

My SIL is an executive with United Healthcare, and she helped me walk through much of it....she says they are even worse!!! Not sure how though!

Call and speak to a person, and find out whether it is employer excluded or what---that CAN be changed!

Good Luck!

Kat

I have BCBS and didn't have any problems getting my surgery approved. I had my approval letter in hand after one week of seeing my MD. I guess it all depends on the state that you live in.

Good luck!