insurance information

Hi everyone, I have recently purchased an individual insurance policy through BCBS/GA. IT's a PPO. I know they have exclusions on obesity treatment, but, it does not state surgical treatment. I am wondering if anyone has had any luck getting approval with an individual policy and/or were there problems with the pre-existing condition clause? I have been researching this surgery for a few years. I am a fulltime student and SAHM so I do not have access to a group insurance policy. Any information anyone could offer would be so appreciated! Take care, Kristy

Hi Kristy, I Have BCBSOFGA PPO as well. They will approve the surgery as long as it is medically nessecary. I called them on OCt 16th and as of that their requirments are: a referral from your pcp, a psych evaluation, and a dietician evaluation, also diagnostic testing, medical evaluations must be passed for clearance of surgery, and a BMI of 40 percent for the last three years. I'm going to see Dr. Duncan in Atlanta, and he has dietician and pshy that he refers you to. Also if you want to attend a seminar for a surgeon you dont need a referral. I would call them and just ask if they do cover it (surgery), and to fax you something stating the requirements. I have heard sometimes you also have to wait until your one year with them, ask that also. When you call ask who your talking to and their ext. that way if for some reason you don't get it, you can always go back to that person who helped you. Hope this helps!

Michelle, Hi and thanks for the response! Coincidentally, I gave BCBS a call today and they do in fact cover the surgery!!! YEAY!! I am so excited. They do have all the same requirements you had stated. They also said there was a 12 month preexisting clause, but I have had NO treatment for anything, including obesity, so I should be safe. I am going with a friend to the "video" consultation with Dr. Dennis Smith tomorrow night. I will probably go through his surgical office. I am just beginning the process, although I have been researching WLS for a while now. What step of the process are you on? Do you have a surgery date? I have heard many good things about Dr. Duncan. Would love to hear more about your journey!! Thanks again and GOOD LUCK! Kristy

Hi Kristy, No I'm like you I'm at the beginning process. I have my referral from my pcp, and I'm going to the seminar on the 30th of this month. So, I know it's going to be awile. I haven't seen anyone for my obesity either. The only dr. I have actually seen over the years is my OBGYN. I just recently went to my pcp for the first time. So, hope fully there wont be any problems, I'm sure I will stimble on some but hopefully over come them.

You will have to have some form of proof of previous attempts to lose weight. All insurance companies are requiring this in some way shape form or fashion now. I have BCBS HMO, and after being denied 2 1/2 months ago and fighting it, I have finally been approved for surgery in December with Dr. Hart. Email me with any questions. [email protected] Christy

Christy, CONGRATULATIONS!!! on your surgery date. You must be so excited and so nervous???? I am glad to hear the appeals paid off :D If you ever want to talk about the upcoming surgery or anything else, don't hesitate to write!! I do have medical records where I was on the medifast program three different times. But they are from about six years ago. I do not have any doctor supervised diets since then. You know how it is, you've heard it all and tried it all. Who needs a doctor to tell you something you've heard all of your life? I go for my surgeon consultation on Dec. 12, so I am hoping to hear back from BCBS in January?? Good Luck..... You'll be in my thoughts! Kristy