Has anyone been approved for surgery by BCBS of Louisiana PPO?
A friend of mine has this insurance and they've been telling her over the phone that gastric bypass is not covered. I was wondering if anyone had gotten approved in the past. She does not think it is because of an exclusion in the policy. She is working on getting a hard copy of the policy, but I thought someone here might know.
Thanks for any information,
Angela
Hi Ash:
I would really appreciate any information you might have. I told her I would try to find some information for her. This lady's doctor is really stressing that she requires the surgery due to her health, however the insurance keeps telling her they do no cover it. She is planning to try to come up with the money for self-pay, but as you know...that is very hard to do and kind of galling when we pay as much for insurance as we do. I'm sure she would be willing to do whatever it takes to get the sugery paid for.
If you get the chance to speak with your friends, you can e-mail me at [email protected] with any info. Again, I really appreciate it. I was able to get all my policy information online, but apparently access is restricted for BCBS of LA.
Thanks,
Angela
It really depends on her employer more than BCBS. Each employer has a different contract with Blue Cross. Most exclude bariatric and plastic surgery no matter what the reason. I work in a hospital business office and while I'm not exactly on the denials/appeals side, I see the notes on people's claims. BCBS is very tight on everything.
I had BCBS of MS in the 80's and needed a breast reduction. My left arm kept going numb and they still denied me. I changed jobs and after 6 months was approved on the first try for the reduction.
A lot of hospitals are doing cash prices for patients now. You do have to remember though that even if you negotiate a price with them, you still have the surgeon and anethesia group to pay. Anesthesia costs as much as the surgeon. Call around to hospitals where your surgeon operates and ask for the Business Office Director. It's surprising to me that doctors don't try to negotiate for their cash patients with the hospital. Hospitals get so little due to managed care contracts these days that they will often take 50% from a cash patient and make more than they would on a patient who has insurance approval. My case is a prime example. The hospital billed United $15,000 but after the managed care discount, they only paid $3,500.00.