BC/BS

Well I talked to the rep at BC/CS today and they are definately nixing WLS as of Jan. 1st. They did say if Lois gets the paper work in soon and I am approved before the end of Dec. they could grandfather me in otherwise NO go. I talked to Lois yesterday and she said she was really busy and didn't have time to look at my chart. I know she only works 3 1/2 days a week so why isn't there someone else in the office that could fax my paperwork to the insurance company. I have planned on this surgery for a year now and I'm going to be really upset if things don't start happening soon. I've done everything they asked me to do and all I want them to do is fax my paperwork to the insurance company. Had to vent. Thanks for listening. Any suggestions??????? Cindy

I might humbly suggest that you go there in person...a live breathing face is not as easy to dismiss as a voice on the phone....you would have a right to ask for all of your records and offer to fax them yourself since they are too busy....!!! I think that practice is growing at a faster rate than anyone can keep up with in terms of technical support like this....I feel for you as I am trying to beat the January deadline and get grandfathered in also....if I can't...then I will change enrollment in May and go to a plan that WILL support WLS. I did not hear that BCBS was going to END covering it..I heard they were gonna make it tougher....unless your company is going to add an exclusion.. At anyrate..you are going to have to get tough and assertive..half of the month is shot... I wish us both luck! Sher'

I just wanted to let you know that BC/BS is not generally nixing WLS it might only be your employer. My BC/BS is still covering it next year but are making it harder to get approved. It is all up to the employers to get the rider to cover the surgery or not. You can contact your human resource department at work and ask them if they plan on covering it in the future. Heidi

Cindy, It really stinks that they are making these changes..... I agree w/ Sher, the best thing would be to go the office and ask for copies of everything and offer to fax it yourself. I know they are very busy, but you should not have to loose your opportunity for a healthy life because off it! Good Luck, Carmen

Hi Cindy, I also have BC/BS and have spoken to a rep who said WLS will still be covered after Jan. 1 as long as it is deemed medically necessary. I've recently begun this process and have appointments through January...I will be devastated if the rep was lying. My rep would not put in writing what she said, but sent me a copy of my benefits. I'm not sure if BC/BS is doing a blanket nixing of WLS or if my division of BC/BS may be still covering it with a rider. I'm going to keep bugging them. I was told at Dr. Aranow's office to highlight the portion of my benefits and submit it to his office as well as call again after the New Year and reconfirm that it is still covered...they said that the reps would have no reason to lie about it after Jan. 1. Not really any comfort in that, though. So, I guess I'm not much of a help to you, but am venting as well. Good luck and keep us posted. Debbi

I am working w/Healthnet on same issue. They are telling me no change from 2004-2005 that it must have prior authorization from their "Authorization group". They will not me what the criteria is becuase they say I could just fake it. now the person who siad this was not being rude but I just question why we can't know the criteria.

Hi Sid! Not sure they really have a right to deny you access to coverage information for ANY procedure..OR medical criteria....afterall...you are paying them..or your employer is...for a SERVICE.... Amused at the "faking it" thing...I know I could not "fake" the 120 extra pounds I am carrying..and can't "fake" diabetes or hypertension..I also can't fake 2 years of medical followup with my PCP.... My instinct tells me that if you called and got another person the response might be different....it will certainly be different if your PCP or WLS office makes the call. Best Wishes, Sher'

By the way...I SO empathize with all of the 'Insurance Anxiety'...(they ought to come up for a code for THAT!)....I have gotten good information from a couple of people...and believe it until I read something ELSE...lol....shame on me....I am in the 'tenderhooks' stage of the game now...have done all the preop stuff and am waiting for "the call"...suddenly all I can get at the RN Coordinator's number is a voice mail....this, after when I spoke with her last week she stated she wanted to get my surgery done by end of DECEMBER...(YIKES).....I was SO ambivalent when I started this..and now am SO commited to it...I will really be upset if it falls through....never knew I would be so anxious to have someone cut my gutts open!!!! I hope it works out for you and ALL of us preops! Sher'

Sher, Thanks for your response and good luck to you. I have called twice now and gotten the same answer. My only, and I do me ONLY, encouragement is that they tell me there is no change from 2004 to 2005. I called my benefits line today and to quote our policy denies surgury except "the medical treatment of obesity which offers a direct and immediate threat to life". Who knows how they will use that against me. My only hope is that my Dr's office WILL call in and get approved for 2004 just in hopes that it might help next year. They initially said they would not do this but I am hoping they change their mind. Good luck again and congratulations!!!

Hi Sid, I am waiting for insurance approval also...AND the date confirmation call....they want to move it up cause of all of the above. I hope your Doc's office will call too..and don't really understand why they won't... I wish you good luck as well and thanks for writing!!! Merry Christmas, Sher'