Hi, I have BCBS-FEDERAL OF LA--I need answers--please help!

Once again, all insurance policies are different. Even if it's BCBS of Alabama or Texas or Louisiana etc... each policy may be written differently because each employer chooses what they want covered and what they don't. (It all boils down to $$$. If they choose a policy to exclude procedures such as Gastric Bypass or Lap Banding etc..., then their premiums will be lower) BCBS Federal policies, meaning you work for a federal agency and choose BCBS as your insurance carrier, have weight loss surgery included as a covered benefit for their employees. An example... with Louisiana BCBS, across the board, gastric restrictive procedures are EXCLUDED in all policies unless the employer purchases a rider to include it. As I understand it, for the employer to add such a rider, it can be very expensive, but some do. I know of four companies in Louisiana that offer BXBS of LA with the rider added on to cover obesity surgery. Alot of insurance companies want you to jump through hoops, some don't. If they are asking for a 6 month medically supervised diet, then get one. Just be sure your PCP makes lots of notes for your surgeon to send in with your letter of medical necessity. It doesn't mean they won't cover it, you just have to jump through their hoops first. If you refuse to do that then the only other thing I know to do is go to your human resources department at your job, or hire a lawyer. I think jumping through hoops will be easier and less expensive. We didn't become this overweight overnight and we most likely will not lose enough in 6 months to keep us from meeting the criteria when we are done with the program, so don't give up. That's basically what they want you to do. I wish everybody could have a BCBS Federal policy so they could get healthy and happy without the headaches, but unfortuately we don't. I had my own problems before finally getting my approval 3 months after starting the process. Yes, it can be a pain, but 7 years later, I see it was well worth the time and effort. Do what you gotta' do. See it through, don't give up.

Ours is not a federal policy-that must be the main difference. My employer does NOT exclude different types of surgery-it is International Paper. Bcbs is simply not paying for the surgery any longer-period. My employer is trying to override their denial. We are changing insurance carriers asap-I am one of many employees being denied necessary health care by bcbs and thankfully IP is going to drop them in January. I don't understand why they are not held liable. I have the medical problems that make this a medical necessity, I have the 6 month diet histroy along with the history of being morbidly obese. Shonda

That is to say BCBS of Alabama/ International Paper policy is not covering the surgery anymore. I really hate to hear that. We have done several people with IP that have had the procedure and are doing very well. I guess they got lucky huh? I did read somewhere that BCBS of AL had a hold on all requests till they could decide what they were going to do with the claims. We have a lady that just finished her 6 mo MD supervised program that will be really angry and upset to find out now, it won't be covered for her. Surely they will see later that they have made a mistake. I hope IP changes to a company that will work with them and with you. I wish you the very best, I really am on your side. It's just that I have seen too many people get mad and not want to do whatever it is they have to do for an approval and just give up. If any body out there reads this and needs some advise from someone that has been on both sides of this situation, please e-mail me. I'll be glad to help if I can, and I can set you up with with best Bariatric Surgery program in Northwest Louisiana. (In my opinion, all of Louisiana!) Just my opinion ya'll!!!

You have done several people with BCBS before November 2004-you keep implying that this is an International Paper exclusion and it is not. BCBS will no longer approve this surgery-plain & simple. Too many people were rushed thru the system with low bmi's and inflated paperwork. It ruined it for everyone. The sincerity of your concern reminds me of why I dropped my appeal for surgery. I could not get Neweigh to call when I was waiting to hear about my status-now I have an idea why.

Several points in your letter make no sense: First-only 1 International Paper employee in Louisiana had this surgery. Second-you imply that I am getting "mad" and giving up-you do not know me. I do not give up. Third-Bcbs does not have hold on requests. They are not approving this surgery any longer. It is not going to happen. Your implication that I did not follow the procedure and finish my 6 program is ridiculous. I quit smoking, kept a food diary, followed the 6 month diet program and had the psychiatric evaluation as well as the sleep apnea tests and yes, I do have sever sleep apnea. Bcbs will not do it. They are not paying for this surgery any longer. Your profile states that you are no longer a patient advocate for a bariatric clinic while you clearly use a message board to drum up business. I can sleep at night-even though it is with a mask on

Hey Shonda, I'm sorry to hear you're having such a hard time... if I were you (just my opinion) I would try one last route... contact the attorney doing the class action lawsuit for those who were denied procedures that are *medically necessary* (link is on entrance page to this site) and see what he has to say about it? Good Luck... stay strong... and don't let it get to you... sometimes, when people can't find answers, they assume things they shouldn't... only you know all the details of what you've gone through... so stay strong and don't give up... Look at it from the bright side... IP will be changing insurance right? Try to find out what companies they're considering, and find out if they have a history of refusing WLS

I'm sorry you see my reply as an attack on you personally. I assure you it is not. I am speaking generally because you are not the only person reading these posts. The original question was regarding Federal BCBS and you made it sound like the original poster would not be approved. Nothing could be farther from the truth. I am only trying to help. I think it is unfair for you to jump in there and give out false information about Tama's insurance company when you only know what's going on with yours. I'm beginning to see why the previous program was hesitant to call you. Although I'm sure they were waiting on a reply from your insurance company, you'll no doubt see it as an attack on you.

hi, THIS IS THE ORIGINAL poster, I love all the baffle over my comment --shows my question was important. I DO know for a fact that BCBS does cover WLS, it is a benifit under my plan which remember is FEDRAL, BCBS of Louisiana will not cover WLS. Okay, but mine is a benifit and I am just praying for an approval, I didn't do my lab work yet or my psyc. evaluation, I am just really concerned cause I do not have any medically supervised diet, except that one that lasted a month!! Thanks