*QUESTIONS* Plz help!!

Hello everyone! I have an appointment with Dr. Fred Harris in Sioux Falls on the 18th to discuss me having surgery. I know that I will have to have an open RNY if I do it as I will be having a partial hysterectomy and my GYN is the one *****ferred me to Dr. Harris, telling me that since I am going to be opened up for they hysterectomy anyway, that I should consider having the WLS. Now, my concerns are....I have BCBS insurance as my main provider thru my *soon to be ex-hubby's* Walmart insurance, and I have Iowa Medicaid as my secondary insurance...Dr. Harris (I was told by his nurse, Sheila), DOES accept the Iowa Medicaid, but when I looked thru the Walmart Health booklet, it states in there that WLS is NOT covered!!! So, now I am really worried. My GYN *thinks* that since I have to have the hysterectomy anyway, that my BCBS may approve of me having the WLS too. Has anyone else had a situation like this...or does anyone have BCBS thru Walmart??? My (ex-hubby) may drop me off his insurance...but I think there is a certain amount of time his insurance will still carry me once we are officially divorced (like 18 mths?). Anyway, I am rambling so will close now and hope that someone has something they can tell me about this. Thank you!! (((((((((((Hugz))))))))))) *Denise* in Iowa

Sorry, Denise, can't help with the insurance questions, but good luck to you. If you don't get answers, post on the main message board. God bless, Andrea

Denise, once your divorce becomes final, you will be eligible for continued coverage on your husbands plan but only through COBRA and you will have to pay for this coverage yourself, this could be very expensive. If you have your surgery before the divorce is final and it is covered by BCBS, your follow-up care will be covered as long as your coverage is in force. As for wether the surgery will even be covered, if there is an exclusion in the plan, chances are they will not cover it. Even if you have it done at the same time as your hysterectomy. When the bills are submitted to the insurance, they will pay for the portion that applys to the hysterectomy and deny all of the others. The majority of the hospital bills would probably be covered, but the surgeons bills would not be. I would suggest you call BCBS and ask them if any exceptions are made to cover this surgery even though the plan book says it is not covered. When you talk to them, make sure you write down the name of the person you talked to, the date and the time. Also, if you don't like the answer you get the first time, call back and talk to the claims supervisor. They are the ones that see the files that the exceptions are made on. Hope this helps! Kris

Thank you Andrea and Kris for your replies. I found out that my primary insurance will NOT cover the WLS . So I guess I am screwed, all I can hope for now is to get completely off my ex's insurance and be able to use the Iowa Medicaid. Hope you all have a great weekend! *Denise* Spencer, IA

Hi Denise, Dr. Harris is also my surgeon! I see him for another consult on the 25th. I had a heart attack in Dec so now we are going to see if he will do surgery at 3 months out & not 6 months out. His staff is FANTASTIC! You will have some time though as you have to attend his seminar as well as the nutrition seminar. Yes, they take care of Iowa medicaid ( that's me). But I'm wondering this, check with your worker to be on safe side. But I believe whatever your insurance doesn't pick up Title 19 will. Worth a try to find out anyway! You might be surprised. I will tell you the nutrition seminar is $135 out of your pocket they won't pay for it. Dr. H's seminar is free. They will break it down into 2 payments for you if need be. Call your worker & ask about this. Good Luck Carolyn

Hi Carolyn!! I am sorry to hear about your heart attack!! WOW, that would be so scary to go thru! Dr. Harris's nurse told me that if my primary insurance won't cover WLS, that Iowa Medicaid as my secondary won't either....I just don't get it sometimes...so, I will just have to forget it all, or wait til the day I am no longer on my (ex's) health plan (it sucks anyway! BCBS thru Wal-Mart!) So now I don't know if I will even still go and see Dr. Harris on the 18th. Well good luck on your 25th appt day! Let us know how it turns out for you!! (((((((((((Hugz)))))))))))) *Denise*