Help I have Blue Choice of SC

Rebechuds · May 7, 2008

Well over two weeks (04/2/08) ago I went to my PCP and got the referrel to the Dr. Givens. I went to the Seminar on Monday (05/05/08) and also got lucky and had my first consult with them also that afternoon. While I was sitting in the office I got the bad new, my insurance wont cover anything dealing with weight loss surgery and I don't have $14,000.00 to pay for this surgery. So now I have to appeal to the insurance to prove this is a medical need and not to just look good but for my health. I'm also needing to send a letter to our senator of SC and to the governor of SC. The state of SC has it where the insurance wont pay for this wonderful surgery. I have BlueChoice of South Carolina. If anyone has them or can help me in getting them to approve this surgery I would appricate it. You can email me on here or at rebechuds@aol.com .

I want to be here for my children to see them grow up and be healthy for the rest of my life. I have for the last month cut back alot in what I eat and have lost 6 pounds but I'm hungry all the time to. HELP HELP!!!!!

georgia girl · May 7, 2008

Hi there. I don't know anything about the insurance, but I just wanted to say that I hope you get your approval. Good luck and keep us posted.

SeattleSweetie · May 7, 2008

Hi Rebechuds, I'm so sorry to hear that they're refusing to approve it. I know it's really discouraging, but unfortunately, it may not actually be the insurance company's decision.

If bariatric surgery is an exclusion in your policy, it's most likely because your employer (or whoever your insurance is through - spouse's employer, etc) has made it an exclusion, usually to help lower their portion of the healthcare premiums.

If that's the case, then the only thing I can really think of is trying to lobby your employer to improve their coverage when they update their plans each year.

I wonder if maybe anyone else here has had any success working with their employer to get better coverage, or even if they found different options to help pay for surgery or anything of the like that might help in your situation?

Update - oops, I should also mention that if there isn't an excludion on your policy, but the insurance company is just refusing to cover it, saying you don't qualify cause of your BMI or co-morbidities or anything like that, then fight fight fight all you can! Some insurance companies will look for any nitpicky reason to save from paying $14k, even if it would save them lots of health care costs in the long run.

Even though my answer probably isn't a lot of help here, I really do wish you the best of luck. I understand how frustrating things like this are.

Edited May 7, 2008 by SeattleSweetie

kathystrick · May 7, 2008

I work for the state too. They actually covered WLS until 2004 and for some reason added an exclusion to their policy at that time. I don't know how you can get your surgery covered, but I have some information somewhere on how to appeal to get your company to provide coverage. I would be interested in pursuing this with you if you want the help. You can PM me here or email at moonchyld70@yahoo.com

Rebechuds · May 8, 2008

Hey Kathy I'm so happy that you finally got approved. Hope everything goes well with you on your banding.

I would love your help in this matter. It's like my world got turned upside down and there is no hope for me. I don't have the money to have this done and I have gotten more depressed about this. You can email me back on here or email me at work rebecca.hudson@scdmv.net or rebechuds@aol.com either will be fine.

Thank again for everyone's advise. Please get me in your prayers.

Big_Houn · September 1, 2008

Hey,

I too work for he state and hae state insurance and was wondering if either of you were successful in getting them to pay for your surgeries. If so how did you accomplish this and where do I need to start.

marek

kathystrick · September 6, 2008

Hi Marek!

I have had my surgery, but it wasn't paid for by the state. Fortunately, my dh's insurance covers WLS, so I didn't have to fight the state about it. That being said, since I am a state employee, I have been trying, although rather unsuccessfully at this point, to start lobbying the state about reinstating WLS coverage. My thought is that at the very least they could provide a rider to our current coverage that could be purchased separately by those wanting the surgery. That way, people who want the coverage can pay for it and those who would never use it won't have to pay a higher premium to provide it for those who want it. The way our policy is right now, you aren't going to be able to get any WLS covered.