Insurane

As many of you have heard a number of insurance carriers are threatening to, or have already stopped paying for gastric bypass surgery. Because Blue Cross Blue Shield has so much of the health insurance market in Alabama we seem to hear more about Blue Cross than other carriers. Blue Cross is now implementing a new medical policy that would make it difficult for many people to be approved for surgery. I have also heard that Blue Cross and Blue Shield in some other states is no longer covering gastric bypass surgery. (Georgia & Florida) Those of you (like me) who have had the surgery, know first hand the tremendous health benefits we have received following gastric bypass surgery, and it concerns me greatly that many people will no longer have the health insurance coverage which will allow them to experience the same health improvements we have experienced. I would be interested in hearing from you regarding your experience with you insurance carrier. Who is your carrier? Does your carrier cover gastric bypass surgery? Does your carrier plan to stop covering gastric bypass surgery? Was it difficult to get your carrier to approve your gastric bypass surgery? We should have a voice in the decisions that these companies are making! I believe it is time that we take a stand in what we believe! Thank you in advance for taking the time to respond to this important matter. Skinny Wishes and May God continue to bless each of you no matter where you are in your journey. Becky PS I apologize in advance if this shows up repeatedly for I am going to be posting this on all boards.

I agree with you. I have written some letters to insurance companies and commissioners about this. I personally really didn't have a problem. My insurance is CHAMPVA and they had gastric bypass surgery in a list of surgeries that didn't need a preapproval but I was lucky. So many have had so much problem and I, for one, disagree that an insurance company that we are paying premiums to should be able to tell us how healthy we are allowed to be. They pay for all the comorbidities we get. Buying meds , treatments, tests, etc but they don't want to help prevent those by approving the one surgery that has been proven to help us live a productive life. I think it is a disgrace. OKAY, I am off my soapbox again. Carol

When I called UHC EPO, I was told I had an exclusion for WLS and that it was not covered at all... So I traveled overseas to have it done, where my dad is in the profession, so my surgery was free (I was very lucky!). Nevertheless, a HUGE inconvenience to have to go across the planet, travel back all stitched up, and now I am having a hard time finding someone to do follow ups... After it was all said&done, I came across my policy, and found out that they lied to me, I did not have an exclusion at all!!! Their answer was "Sorry, it was just misinformation, you should've double checked, plus we have no records of you calling us, so how do we know this even happened??!!!!" Anyway, in my opinion, they don't only add exclusions, they also lie about it when they don't add exclusions... How fair is that?? I spoke to a friend of mine in KY who attended a seminar just a few days ago; her hubby is the one looking to get WLS. She informed that she was told in the seminar that insurance companies are just now realizing that it is much cheaper to pay for 1 surgery than to pay for a life time of comorbs. The people who deal with the insurance, in the particular clinic that offered the seminar, explained that they DO see the light at the end of the tunnel, but that it would take about 4 years for Ins. companies to become WLS friendly. I was shocked when my friend told me that, because all we are seeing at this point is a complete OPPOSITE trend. I do hope they are right, I do hope it all changes... but at this point, it is all talk... Just my 2 cents... Hope this brings hope to some of us. -Flávia

I have BC/BS PPO (Florida) and didn't have too hard a time getting approved. My biggest hurdle was that my PCP closed his office and I couldn't get records from the past few years. I did get older records, file a complaint with the state about the PCP and made sure to send copies of everything I did to BC/BS. Anyway, we just got our new policy and WLS is NOT covered under any cir****tances any more. But not only that, they will no longer pay for weight loss drugs, counseling, exercise programs or anything else related to weight loss! So Florida BC/BS sure hasn't seen the light as to helping people lose weight and get healthier. My new PCP says that on average, people's insurance carriers change every three years and they are betting if you need help with a problem directly related to weight, you'll be with another company and they'd be off the hook for the cost. Don't know if that's true, but he's happy that I was able to have the surgery and take the weight off. I think he realizes that for some, it's the only hope to do so. Linda

I have UHC thru my employer and I was told we had the same policy as we had last year which was medically necessary. I contacted a wls doctor amd signed up signed up for the orientation, contacted a psych and set up an appt. I went to my pcp and signed the papers for the records to be sent to the wls dr. I went to my cardiologist and orthopaedic dr and had the records sent to wls dr. Last week I got our ins benefit book that started Oct 1 and wls is an exclusion but my human resources office said I could file an appeal if I was denied. I called the wls dr's office and asked about exclusions in benefit book and was told that there is no way the ins company will pay for it appeal or not and it was my HR office that added the exclusion. I then went back to HR and they agreed that since it was an exclusion I couldn't get it paid for no matter how many times I appealed. The HR office mislead me and them admitted it was excluded after telling me the policy was the same. I also got another shock when I went to refill a rx and it was $35. instead of $14. I work for a transit company and if at all possible I would go to work for another company just to get this surgery. its terrible being overweight and I don't see any other way of losing 110 lbs. Thanks for letting me vent BettyC