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Clarification needed

Sida

By Sida, in Insurance & Financing

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Sida    0

Sida
Posted

Hi all! I've been a lurker for awhile and have been browsing this forum. I meet the criteria for lap band, but my company has an exclusion for WLS under BCBS in Georgia. I've seen several people who have won appeals, and I need to know whether you can appeal an exclusion or if the appeal was just because the insurance companies covered WLS but didn't want to approve it right away for whatever reason. I'm a little confused on the formalities. I really can't afford to pay out of pocket, but I think there may be a chance for my insurance to cover it from what I've read here. I would appreciate any help so much!

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Mink    0

Mink
Posted

Exclusion in 99% (or more)of the time means the end of the road for insurance paying you can do what I did and shop for a doctor for self-pay.

My company has an exclusion but we did get them to cover pre-op tests.(they did not cover them for my surgery but my reflux)

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Chunkymonkys    0

Chunkymonkys
Posted

Sorry to hear about your policy :thumbs_up: I have worked in the insurance field for a long time (BC being one of them) and when you have an exclusion on your policy, there is no way getting around it. Applealing does no good. Once it is written into your policy, that's that sadly. Your best bet is to go to your employeer benefit person (you know, the one that no one really knows but writes up the policies) and ask them if they are going to consider covering it in the future. It will probably be futile, but what do you have to loose right? I ended up changing jobs to get mine covered lol.

Sorry to be the bearer of bad news, but I didn't want you to have to go thru a bunch of hoops to only be crushed at the end of a long drawn out battle.

Good luck!

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nip50    2

nip50
Posted

Sida - Sorry about the insurance. I also have BCBS of GA and they're correct. No way. The only way they will pay is if the company you work for paid extra for a waiver to cover weight loss surgery and so far, I haven't heard of any company that has done that.

What part of GA are you from? I'm down south in Douglas and was banded in Albany by Dr. Bagnato, self-pay of course. I had part of the money on hand and borrowed some from a relative. Can you do it self-pay? It is so worth it. I don't regret it for a moment.

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Sida    0

Sida
Posted

Thanks everyone for the helpful info. I'm in the Metro Atlanta area. Still deciding on who to go with, still doing lots of research. I will end up probably paying half cash and financing the rest somehow. I just got out of debt, I really don't want to do that again. But, it'd be worth it.

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Go To Topic Listing Insurance & Financing

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    • Doughgurl

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      1. Selina333

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    • Alisa_S

      Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 1 reply
      1. LeighaTR

        LeighaTR

        I hope your surgery on Wednesday goes well. You will be able to do all sorts of new things as you find your new normal after surgery. I don't know this from experience yet, but I am seeing a lot of positive things from people who have had it done. Best of luck!

    • Alisa_S

      Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 1 reply
      1. summerseeker

        summerseeker

        Life as a big person had limited my life to what I knew I could manage to do each day. That was eat. I hadn't anything else to look forward to. So my eating choices were the best I could dream up. I planned the cooking in managable lots in my head and filled my day with and around it.

        Now I have a whole new big, bigger, biggest, best days ever. I am out there with those skinny people doing stuff i could never have dreamt of. Food is now an after thought. It doesn't consume my day. I still enjoy the good home cooked food but I eat smaller portions. I leave food on my plate when I am full. I can no longer hear my mother's voice saying eat it all up, ther are starving children in Africa who would want that!

        I still cook for family feasts, I love cooking. I still do holidays but I have changed from the All inclusive drinking and eating everything everyday kind to Self catering accommodation. This gives me the choice of cooking or eating out as I choose. I rarely drink anymore as I usually travel alone now and I feel I need to keep aware of my surroundings.

        I don't know at what point my life expanded, was it when I lost 100 pounds? Was it when I left my walking stick at home ? Was it when I said yes to an outing instead of finding an excuse to stay home ? i look back at my last five years and wonder how loosing weight has made such a difference. Be ready to amaze yourself.

        BTW, the liquid diet sucks, one more day and you are over the worst. You can do it.

    • CaseyP1011

      CaseyP1011

      Officially here for a long time, not just a good time💪
      · 0 replies
      1. This update has no replies.

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