Insurance?

I am confused and a little miffed. Last Wednesday I called myinsurnace company because I wanted to make sure that they will cover an echocardiogram. The good news is that they will. The bad news is that while I had them on line, I asked about WLS, and of course the answer was no. I aksed for a complete policy description in writing, but they don't issue that. "too many changes happening all the time". They referred me to the summary on the internet which is nearly useless. I called my husband's emplyer directly, and they don't send them out either. Our insurnace is with BC/BS of IL Traditional PPO because my husband works for a nation-wide company whose headquarters is in IL. We live in Georgia, where I hear insurance companies are not allowed to exclude WLS. My PCP is very supportive because I have Diabetes, hypertension, and a family history of early death. My BMI is 48. Here are my questions: 1. did I make a mistake masking the questions? Am I a "marked" woman now? 2. Should I proceed surgeon "shoppong" or do I get into the insurance fight first? In other words, do I let one customer service twit alter my plan to proceed. 3. As I approach the surgeons in town to start my process, should I let them know what I was told on the phone? 4. Does the Georgia Law protect me in any way? 5. Has anybody worked with ObesityLaw.com and can you provide me some feedback? 6. Has anybody reached out to their labor union for help? Any encouraging words and advice will be appreciated greatly becaue I really need this surgery. Havi

Hi Havi ~ No, you are not a marked woman. Call again and ask someone else. Ask them to read the actual policy about weight loss. Is there a direct written exclusion for the treatment of obesity? If so, you are screwed. Just like me....... I am trying to find a job that covers the surgery because I desperately need the surgery too. If it says something about the surgery only being covered if it is medically needed then you are good to go. Have your physician and surgeon write letters to the insurance and formally submit a request. You will get a letter back, or at least the Dr. will. The letter will tell you if there is an exclusion or if you don't qualify because of your health. If you don't qualify because of your health then appeal their decision with more data and letters from your doctor. They should help you. Good Luck !!! While you are on the war path check this out: Sign petition & make Ins. Co. pay for WLS a law! Your help is needed! Click on the link below to help make this happen! And don't forget to write to your congress members. http://www.PetitionOnline.com/07221976/

Havi, First, there is no such law in GA. Second, though, I think it is law the insurance company has to provide you with a copy of the complete policy. To verify that may I suggest you email Sandra Lilly. She is an attorney in the Atlanta area, who has had WLS and focuses on these problems. She could tell you at first where you stand with seeing the entire policy. Her email address is [email protected] Maybe she can get you started Cathy Gogan

Cathy, Thank you for referring me to Sandra Lilly, I made need her help. As far as the law, it does exist. It was introduced in 1998 by Nadine Thomas and it passed. If you go to the state's legal web site, you can find it. BTW, Nadine Thomas may be running for Zell Miller's Senate seat. Thanks, Havi