carefirst bc/bs

WOW!!!!!!!!!!!!!!

I do these reviews asw a nurse. we have 15  days after  it is called in to give a determination. legally for prospective surgery
if all the info is there and meets criteria those I jump on first to get knocked out. I have carefirst bc/bs. took them only 4 days to get back w my approval. ( don't work for them )

It's funny, I came on the Maryland forums (I am from MN but my BC/BS is from Maryland) and I was just looking to see if anyone else has run into what I ran into.  BCBS is telling me that the WLS is specifically EXCLUDED from coverage in my PPO plan.  At this point I am going down the self pay route, however I am wondering if anyone else had run into this and knows of a way I can get around it....any ideas?

I have Carefirst Bluecross Blueshield PPO and I was covered for my surgery in 10/2007

It may be that your employer decided to exlude it :  check with your h/r dept.

It is that my company decided to exclude it - you've got it exactly right.  I don't entirely know what that means but from what I understand as of right now, that means there is no appeals process and I can't do much but proceed with self pay.  I am completely willing to do that however I just wanted to make sure that I'd throw this out there in case someone knew of another way around it.  There are no other plans or options from my employer that I can wait to sign up for at another time so I won't have another option later or anything.  I'm really more worried about any follow up care that they will say was a result of the wls which will not be covered because of that.  Thank you all SO much for your help and insight.  I appreciate it!

Have you talked to your employer?  Depending on the size of the company your owner or HR dept?  They may be willing to work with you... 

Wow, i read thru manual when i first started working with the State of Maryland and i certainly didn't read any exclusion to WLS coverage.

I don't understand that. 

me either my carefirst bc/bs open acess is out of delaware even though were in md, it does not say anything about excluding , just that you have to be severly obese or have one or more of the comorbidities well lets see MMMMMMMMMMMMM i got divaticulious, copd, diabetes 2, high chol (600) high tryglicerides (1200) and no meds or diets will  take the number down diets dont work either im just as salt free as ever, not a big bread and potatoes girl so go figure doc said it is heriditary just my luck hugh **** think i will be approved? i hope so****

Hi grammom:  You should definitely be getting your approval soon. BTW, have u heard anything back from docs office yet.  If she goes ahead  and leaves for vacation b4 you all get an answer back - will she leave someone with your paperwork to call you as soon as they hear. 

You know, one monkey don't stop no show! LOL