Devastated by Blue Cross and Blue Shield

Kat817 · February 27, 2008

Sending ood wishes your way Nicole!!!

Kat

Kat817 · February 27, 2008

GOOD ones too!!!!

LOL

Kat

NicoleW8ing · February 27, 2008

Lol! Thanks Kat!

BTW, looking at your weight ticker is very inspiring. Awesome job!

bandster_1007 · February 27, 2008

i have bcbs, and my policy had a written exclusion for any obesity treatment.

i was a self pay.

CMPW · February 28, 2008

Good luck. I just received my band on 2.11 and I have BCBS of AL. They approved me with no problem and I too am 5'8" and WAS 330lb at time of the surgery, (now 304). There was a lot of paperwork but I called them, asked for a detailed list of what they wanted and then preceded to get all of the documentation myself so that I could ensure that it was done correctly. My BMI was 50 and I have suffered "morbid obesity" for 5+ years now. You should be ok. Good luck.

bandster_1007 · February 28, 2008

good luck to you from me also. i just realized how morbid my post was.

i have bcbs advantage though, and it is different.

i know a lot of people that get approved through them at my doctor's office, even people with high BMI's. my doc pretty much only does lap band now and most of his insurance patients are bcbs.

CaliGirl626 · February 28, 2008

Good Luck to you Nicole.

I have Blue Shield, my problem is a bit different from you. For me, the insurance said that I'm not big enough and I do not have enough Co-morbidities for them to pay for the surgery.

I haven't had the WLS yet, but I'm working on that. I spoke to my doctor and she said that if I can do it, it would be good for my health. It's very upsetting to see that the insurance company hold the power to say "yay" or "nay" on our health. To them, we are just a claim number that help them boost their profit margin.

I will be paying for the surgery on my own. My husband and I decided that my health is important enough that we are going to Refinance the house and pay for the surgery. So, to have a 20 years loan on our house and having 2 healthy people working towards paying that off is way better than having one healthy person and one not so healthy right?

Sorry this seems to be like venting. I guess what I'm trying to say is to go with something you are comfortable with. After all, it's your health, it's your body. As you get older, you might change jobs and change insurance coverage. So don't let one company stops or alter what you really wanted. Fight for it~!!

NicoleW8ing · February 28, 2008

Good Luck to you Nicole.
I have Blue Shield, my problem is a bit different from you. For me, the insurance said that I'm not big enough and I do not have enough Co-morbidities for them to pay for the surgery.

I haven't had the WLS yet, but I'm working on that. I spoke to my doctor and she said that if I can do it, it would be good for my health. It's very upsetting to see that the insurance company hold the power to say "yay" or "nay" on our health. To them, we are just a claim number that help them boost their profit margin.

I will be paying for the surgery on my own. My husband and I decided that my health is important enough that we are going to Refinance the house and pay for the surgery. So, to have a 20 years loan on our house and having 2 healthy people working towards paying that off is way better than having one healthy person and one not so healthy right?

Sorry this seems to be like venting. I guess what I'm trying to say is to go with something you are comfortable with. After all, it's your health, it's your body. As you get older, you might change jobs and change insurance coverage. So don't let one company stops or alter what you really wanted. Fight for it~!!

We simply can't afford it without insurance. I'm young, as is my fiance, we have 0 established credit. We both work full time and are in school school full time. Unfortunately, there's not enough money to go around, you know?

Thank you for your kind words. Your thought process makes a lot of sense and it is good to hear that you and your husband decided to go with the healthy route.

It's one thing that really irritates me about this country... how the health insurance companies rule the roost. If my doctor and I agree on a procedure being healthy and extremely beneficial for me, I don't understand at all why an insurance company has any right to deny it, whether you're underweight, overweight, whatever...

C'est la vie.

Thank you again!

wrestlersmom · March 1, 2008

I have BCBC of ALabama..But I have heard BCBS NC is outstanding.. I can send you the bi laws I am more than sure they are the same..contact me at

wrestlersmom125@bellsouth.net

my name is Rose and I live in Rutherfordton, NC I am all done with everything and waiting for paper work to go to the Insurance..

swantime · March 1, 2008

i have bcbs,,,,,they approved me without any problem,,,,,,,

NicoleW8ing · March 3, 2008

Hey guys--

Again, thank you for your warm wishes, your sharing, your experience, your time, and your support. I love this forum so much.

Once I know everything for sure, I am going to create a thread in the larger weight loss forum so those of you with higher BMI and BCBS know what to do...

Here's my log of this morning:

Calling BCBSNC's Utilization Management team (the people who do the denials and approvals) revealed that I did have all my paperwork correct and the only basis I was denied on was the BMI. Good to know... they also said that I probably would not need to appeal, that a call from the doctor to the insurance company's doctor (they call it a peer to peer review) would be all I needed to get it most likely approved.

It seems that my problem is not with my doctor specifically OR the insurance company. It is my doctor's support staff. Unfortunately, my doctor's support staff was BEYOND unhelpful this morning. They simply told me that I could contact Capital One for financing. I considered this obscene.

They told me my doctor was too busy to deal with the insurance company. Considering my surgery is being billed for $23,700, I find it hard to believe he's far too busy for 15 minutes of my time.

I emailed him. He called me within 45 minutes and told me he would be contacting the Medical Review Coordinator and BCBS today. This is a step in the right direction and it keeps me out of the appeals process so I do not have to lose my March 19th surgery date.

I'll keep y'all posted. As soon as I finish everything, whatever method I have to take to get this surgery approved, I'll be posting a guide so the next person does not have to deal with this. I've had 3 panic attacks in the last 48 hours, nursed through by Xanax and rest. Undue and completely unneeded stress.

Love ya guys!

Nicole

Maya314 · March 3, 2008

Nicole,

I'm so glad you emailed your Dr, there's nothing worse than a receptionist with an attitude! I've worked in the medical field for many years, I strive NOT to be a barrier to help that patients need but someone who can bridge the gap wheter or not that come in the way of further educating patients or being the go between for them. Good luck! Please continue to keep us posted, I'll be interested to see how things turn out for you!

I'll be sending good thoughts and prayers your way!

swantime · March 3, 2008

nicole,,,tell your doctor about the hard time the witches gave you,,,,tell him perhaps you need a different doctor,,,as i said,,,i have bcbs and had no problem getting approved,,,,,,,the follow up with lapband is extensive,,,do you really want to deal with those idiots,,,run this by the surgeon,,there are others

NicoleW8ing · March 3, 2008

nicole,,,tell your doctor about the hard time the witches gave you,,,,tell him perhaps you need a different doctor,,,as i said,,,i have bcbs and had no problem getting approved,,,,,,,the follow up with lapband is extensive,,,do you really want to deal with those idiots,,,run this by the surgeon,,there are others

Truth be told, I don't want to deal with those people. I have another doctor lined up for my follow-ups. My mom works has worked in the hospital where he operates for a very long time. She prefers me to go under his knife than anyone else's. I am deathly afraid of doctors, surgeries, the whole deal. She trusts his slicing and dicing abilities more than the other doctor, though the other doctor has a MUCH better bed side manner and friendly support staff. I'll be switching after the operation. GAH! The idea of dealing with them for a lifetime after my surgery makes me cringe.