If Ins says they no longer cover???

I had already posted another topic, but I also wanted to see if anyone knew about this......

Well, I called my BC/BS this morning (I had called two years ago and they said they covered at 100%, but I chickened out). Guess what they said this morning?........ the group has decided that WLS is not covered so all the bills would be on me!!!! I am so mad!!!

When I called a friend of mine, she said that if you get a letter from your DR. saying that it is medically nes. they still have to cover it. Does anyone know about this?

I think I may have posted under your under question this same responce.  We are on BCBS PPO and inquired about having our surgeries covered.  BC says that my husband work has opted out of that coverage.  We asked even it is medically necessary and she said no.  I have heard of people trying to appeal that and 2 years down the road they are approved or still denied.  I know if I had to go to all the dr's they wanted me to go to and fill out all the papers and do appeal after appeal that I would drop out.  I don't want to go through all of that and 2 or 3 years down the road they say a final no.  And I have spent 2 years of my life getting even heavier when I could have been skinny.

Just my opinion.

But perk up if you ever develop a drug addiction BCBS is all over it.

I don't have any advice, but I wanted to say hi.  I'm from Griffin.

Kim

My heart has just hit the floor.... do you have BCBS's Federal plan or anothe BCBS plan?  I have the plan for federal workers and was told they cover the surgery with medical necessity and a BMI of 40+.... I guess I will see soon... my doc submitted my request for surgery yesterday and I am a basketcase on this... I pray they say yes....

I do hope all works out for you.  I have read on these boards about people fighting medical necessity assessments by the insurance but if it is an exclusion, its almost impossible to get them to pay for it.....I will pray all works out for you too.

Dee

 

 

Dee

I have BCBS Federal and it is covered.  They cover at a 40 BMI for all and a 35 BMI if you have co-morbidities.  My BMI is 35 and I am diabetic and had my approval 2 days after the surgeon's office submitted my request.  Was almost too easy!

Thank you so much, that  makes me feel better.  My BMI is 43.4 as of last week, so I think the BMI part meets the requirements... I am waiting on something from BCBS, but it hasnt been but just a few days.  The Dr offie said it could take up to 3 weeks for an answer... I hope not that long.  The only problem I see is that I have only had the insurance for 8 months now and I read that one poster said they told her she had to have coverage for at least a year.  So hopefully that isnt the case with the Federal plan.... I have done a lot of research and havent found anything saying that... so I sit .... fingers crossed and praying for good news to come my way.....

Thanks again for the post,,,,

Dee

Dee,

I, too, have BCBS-FEP  and I switched to them in January 2008 and I got approval!  SO, that shouldnt be a problem!

-Kelly

Thank you, that makes me feel better about waiting, there is hope...

Dee

Make sure you read your policy and any exclusions listed....once you know the wording it will help you determine your next steps.

I have read it several times over,, looking for the fine print and as of yet have not uncovered anything  that says I have to have it for any length of time... keeping fingers crossed......

dee