PLEASE HELP! New here and I need some questions answered...

Hi everyone! I hope this message finds all of you well. I have some questions and I sincerely apologize if they have been asked and answered before. I have just spent the past hour on a very slow computer trying to find the answers that I am looking for. I am nervous about BC/BS of LA not covering my surgery. I have not tried to get coverage yet because I am afraid of being turned down. My questions are: 1. Will they turn me down if I do not have a history of medically trying to lose weight? I was too embarrassed to go see a doctor about my weight. I am 5'8" and weigh 240#. 2. I do have family history of heart disease on both sides (my father (40 yrs old), uncles, grandparents all died of heart disease at young ages) and diabetes family history also. Will this be enough to approve me? 3. I do have a history of depression. I am on medication right now and have steadly gained weight with it, especially when I tried to get off of it. I thought I was going insane - literally. Will BC/BS take that into consideration? 4. Should I change insurance companies or add an insurance company that will be less strict and approve me? Any help or advice someone could give me would be greatly appreciated. Thank you

Hi CR,I have BC/BS and I am on my second appeal.Does your insurance have an exclusion for grastic bypass surgery?If they do you are in for a fight.If you can add insurance do it.But make sure they cover the surgery.Check your BC/BS book to see what it say.If it doesn't have an exclusion then they might cover for medical reasons. Good luck Sarah

Thank you Sarah for replying. I have read my contract and I do have an exclusion in there. I am thinking about adding some insurance, but not sure how to go about it. I don't think I can just ask them if they cover this surgery because then they might not insure me. Oh well, I will keep trying. This is my life I am fighting for. Good luck with your appeal. Thanks again! Cindy

CR, I just read your letter. I feel for you honestly I do. I to have BC/BS of La, and I can tell you there is NO WAY it will be covered. They excluded no matter what. Its a written exclusion and no matter what evidence I sent to them they immediately turned me down. SO I went and found a job whose insurance covered it. They approved me within 2 weeks, and that was after fighting BC/BS for almost 2 years. The funny thing is that I still have BC/BS as my secondary insurance and they paid some of my bills for the surgery, I guess they didnt look to closely to the claim that was sent in. I wish you all the luck in the world, but please find another insurance. And the good news is, that since you have credible coverage right now, HIPPA will take effect and there won't be a pre-existing clause. Please read my profile, I tried to document my case well. Good Luck! Leslie

Thank you Leslie! I am so glad that I found this site and forum. I am also very excited for you that you are finally able to have your surgery and have it covered financially. I hope all goes well. I will be praying for you. Thanks again! Cindy

Just wanted to "WELCOME" you to the FAMILY!!! Hope you find this site as useful as I do. I joined in December 2003 so I am still gathering information myself. The memebers on this site are "VERY" Wonderful and Helpful people. They will make you "FEEl" more welcomed here then any other group on-line that you will EVER join. Feel free to post messages on any state board you like until you get all of your questions answered. We are ONE BIG HAPPY FAMILY here at ObesityHelp.com!!! I am scheduled to have my surgery on FEBRUARY 12, 2004 at Harper Hospital here in Michigan. I check this site daily to gather good sound advice & information that will help me through my WLS journey. Take Care!!! Alicia

Thank you Alicia for the great welcome. You are right in that this site is very helpful. I hope that your surgery goes well. Take care. Cindy

Try to get a policy with Ochsner. I have a friend who wanted just insurance on herself and got he OHP. She was covered for bypass. Good luck to you!

Thank you Peggy for the great advice. I will look into OHP and see if I can't get on board with them. Thanks again! Cindy

Thanks to everyone who has responded to my post and emailed me with some VERY good advice. I am in the process of looking for a new insurance company, especially since BC/BS has now raised my premium to one hundred dollars MORE a month. They have lost their mind. Thanks again!!