question about insurance

Hello.  Has anyone dealt with BCBS of KS. My insurance policy says that they don't cover anything having to do with bariatric surgery, dr. visits about weight loss, etc. Just wondering if anyone has fought and won this problem? thx, gin

I also have BCBCKS and they will not touch anything to do with weight loss.  I'm hoping someday they will loosen up on this.  The money they could save on with just the payout on prescription meds alone would be enormous.  Maybe they don't have the faith that this surgery works.

Thx, Bettye

I had BCBS of KS for years, and they were and are awful when it comes to WLS. I don't know of anyone who has gotten them to cover it.  I've had to wait years and have declining health until I've just now been on disability long enough to get Medicare, which will cover it.  During the years I had to wait, I did once write various KS legislators after reading the info at the OAC (Obesity Action Coalition) about a desire for legislation like some other states have that requires WLS coverage or that the companies at least offer a plan that includes WLS, but I guess there isn't the political will from more people in KS to get this.  Sen. Barnett from Emporia has done some work promoting such legislation, but it hasn't caught on here.  I remember I got a response back from Insurance Comissioner Sandy Praeger, and I think she was opposed to such a law, or maybe didn't state her opinion on it, but said her concern was that mandates like I am in favor of would raise rates.

thanks for the reply.  I have heard this a lot about bcbs.  i got on this website (right here connected to OH) where you can hunt for health ins and companies will call you and give you quotes.  Well the same night i entered my info i got a call from premier healthcare online and they were having open enrollment.  I signed up right then. So i actually got ins that would cover the surgery. At least thats what im being told.  I havent got the ins card yet.  I am meeting with the surgeon this wednesday, so i guess i will find out.  The ins is kinda pricy but its going to pay 90 % up to $7500.  So thats lots better than 100% comin out of my pocket.  My mother thinks it might be a scam or something, but ive had contact with the company over the phone many times and they have always been helpful.  So I'll see. 

Do you have a surgery date scheduled or what step are you at?

That is interesting about the new insurance you are dealing with.  I hope they are legit!  Perhaps you could call or check the website of the KS Insurance Comissioner and they might be able to say.  I went to your profile and see you are interested in the gastric bypass or the duodenal switch.  The costs for these are way, way higher than $7500, such that I know I would have no possibility of paying the difference.  I think the self-pay listed price from Tallgrass in Topeka is $24,000 for the gastric bypass, and they don't even list the price for the DS, but I would think it's more.  Of course, maybe your insurance would have a negotiated rate that is lower, but I still think it's unreasonable of insurance to have such a low limit on how much they will pay for WLS, although, like you say, better than nothing.  Even just the pre-op tests and appointments I would not be able to pay on my own. 
I went to the first seminar interested in the Lapband, but after reading more and more at ObesityHelp, I came to want the DS.  The RNY has never held much appeal to me.  I went to my first WLS seminar in Arpil, the one for Tallgrass.  I had to wait until the Medicare took effect to start pre-op appointments, since BC/BS of KS wouldn't cover them.  But, now it can be a challenge to find providers who accept Medicare, since it can be a lousy reimburser to the professionals.  I had my psych eval first, since I really did not know if I would pass it, and I was not going to do the medically supervised diet (that the contractor who administers Medicare for KS requires here; this varies by state) unless I had passed!  Luckily, I did pass and can proceed.  It stinks to me that at Tallgrass if you have a better private insurance that covers WLS you can get a surgical consultation apt quickly (after attending the seminar and turning in forms), whereas if you have the stinkier Medicare that pays the surgeons much less, we have to jump through many hoops, including a months-long supervised diet, before we can even find out if the surgeon will take us on as a patient.  Then, even after that, there can be more of a wait for a Medicare patient to get scheduled at St. Francis in Topeka.  Bettye said she was told St. Francis Hospital here only lets four Medicare bariatric patients be scheduled there per month.  
I have also watched the seminar-on-DVD from Dr. Anthone in Omaha, Neb., for out-of-area potential patients.  It also came with a packet of articles from his office when I called them.  He mainly does the DS, and takes my insurance.  It says they want the DVD mailed back, so I need to be getting that back to them.  On the DVD, he said he will occasionally do a Roux en Y.  He has 13 pages of mostly excellent reviews here on ObesityHelp.  The reviews on OH and his policies sound like he doesn't treat anyone like a second-class citizen.  There are various pros and cons with the different choices of surgical groups.  Travel costs even just one state away would be an issue to me, but I think I could make it work if I had to.
 

hi. I can't believe you have had so much trouble with just getting your surgery underway.  its sounds like the dr in nebraska might be the better way  to go.  my husband and i went up there this summer and stayed in a microtel for a couple nights i think gas and motel only cost $200 if that.  money is tight for us too, but i feel the benefits of the surgery will outweigh the risks of staying the size i am. 
i also went to a seminar in topeka for tallgrass.  I thought they were really good until i went to a dr in lenexa ks.  (minimally invasive surgery hospital, dr kawenski) I think that how its spelled.  anyway. They totally blew tallgrass out of the water. I went to a seminar and had my 1st consult this last wed. This surgeon, Dr K,  spent 2 hours talking to me, getting to know me and asking me probably 100 questions about my health and such.  Her knowledge amazed me.  She told me things about the meds i was already taking that no dr or nurse has even breathed a word about. They have strict rules to follow and *a rewards system* where you can earn free dr visits and even free plastic surgery procedures.  Thats a big plus as far as im concerned.  I could never afford plactic surgery-tummy tuck is one of them. Every surgery they do is done laparoscopically.  tall grass just kinda struck me as in it for the money. ya know. do the surgery collect the money. NEXT!!!  (but i never went to a consult so i could be totally wrong. hope my opinion doesnt offend you, not my intention.)
now as far as the DS  I went to MISH center in lenexa totally set on the ds.  She gave me all my options and now im leaning towards the roux en-y.  which i never thought i would. considering my weight, bmi, age and such I think the ds may be too risky.  the thing that really got me was the frequency of bowel movements and the flatuence.  Dr K said that most ds patients have really bad flatuence and that it can even come out thru our skin.  its doesnt just last for a few months but the rest of our lives.  she has seen patients lose friends over this and even their job and after they lost the weight.  I am a restaurant manager so that would be a very bad side effect to try to deal with while im on the job, ya know. so thats what turned me off from that.  So im stuck between the sleeve and the roux en-y.  If I do the sleeve then i could always go back and do the second part and turn it into the ds.
also thanks for suggesting the link to check out that new ins company.  i'll do that tonight.  Dr K said that if its not in writing don't  believe it.  so ive got some more researching to do.
thanks ginger

Thanks for your reply.  I am so interested in your description of Dr. K as a possibility in Lenexa.  I've really wondered about her.  I have read  her reviews here on ObesityHelp, and read her own web page.  The reviews I recall being quite good, but I really wondered why none of them were from DSers. Also, I was so disturbed that she even listed BPD (the old kind, without DS) as a possibility.  If I recall, she said she had done about 25 BPDs and 25 DSs (but those web stats could be a few years old).  Most of the people on the DS message board who have had it say that it is just a myth that DSers have a stench about their whole body. Many also report that the flatulence is controllable by their dietary choices, for the most part.  The most common cause for the flatulence in DSers is usually white flour, sugars, and sugar alcohols.  If they stick to protein and fat, most do not find it too bad.  Then, they often just have, say, a cookie from work in the last hour, so gas won't hit until they've left work, or they wait to have starchy food until alone at home in the evening.  That's what I seem to see them saying on the DS board.  Have you lurked much on the DS message board?  Of course, I am still thinking about which WLS I can best live with, and I am kind of grieving, in that they all can have bad things result.
Oh, I wanted to also bring up more about Dr. K's website.  I read these a few weeks ago, I think it was.  I read the 34-pg DS guide she had in .pdf, and it seemed like mostly just repeating RNY dietary habit advice.  Like your statement in the post above, I don't mean to be offensive about other people's choices, either.  I am just concerned.  I hope she is better than my fear of her.
 I am so impressed that she met with you for so long!!!  That counts for a lot with me. 
I do know I have a beef to pick w/ Tallgrass's bariatric web site, too, in that it basically just has a little ad for lap-band and it's financing, then a little about each surgeon.  Nothing substantive about DS or RNY.  And yet, I do know that at the seminar, the different options are presented pretty equally, and I do read the posts of a woman who went to Dr. Berntsen at Tallgrass intending on getting the RNY, and Dr. B suggested the DS for her, and she (the patient) has been very pleased with the DS post-op.

Edited to add: I meant to put in but forgot:  I wonder if she (Dr.K) was mixing together the old BPD and current DSers in what she was warning you about as the terrible things that could come of the DS -- I think those were more prevalent with the old BPD, which is why it isn't normally done anymore, when the modern DS is so much better.