Starting this Whole Process Over

Hey everyone. I have a few questions for you all. I started looking into WLS last summer and have been bashed at every turn. I have a new job now with Blue Cross Blue Shield insurance. I think there may be a restriction against WLS on it, but I am not sure. One of the principals at the school where I work had it and her BCBS insurance covered it but she had to fight them...... Anyways, my questions::: 1. What information do I need to present to them to get the process started? 2. Where do I start? 3. Do I need to find a surgeron first so they can help me fight this? 4. I know they need documents about family history... My grandmother and grandfather are both deceased, but their dr's know that I took care of them. Would their doctors give me their information so I can use it to build my case???? Please, if anyone has any suggestions, thoughts, loop holes, PLEASE let me know. I so need this so I can have a real chance at life. Thank you all so much for your time. I hope to be on the loosing side next summer!!!! Everyone, please agree with me and pray for that! Kimberly Dawne

Kimberly, The place I use to work at before I became disabled had BSBS of Missouri. They also had WLS exclusions. I wrote to everyone in the state and never could get approvel. My company had an air tight exclusion clause. You need to talk to the person in charge of insurance for youe employer. I have several severe comorbidies and it didn't matter. Good luck to you and never give up!

I would ask for a copy of the plan so you can see if it is excluded or if there is hope for having it approved or appealed. Then I would decide which surgery I wanted. Be sure to check out all of them, as they are different as far as post-op life. Then I would find the best surgeon I could get to, even if he/she is miles away. Most surgeons' offices will help with insurance submission and even fighting for an appeal if you need that. Good luck in your journey. I hope it all works out for you. ______ Jeanie in St. Louis Duodenal Switch (DS) 02/12/05 - Medicare Approved Dr. Gary Anthone - Omaha NE 5'10" - 348/250/165 -98 big lubs Read about the Duodenal Switch surgery at http://www.obesityhelp.com/morbidobesity/surgtype-forums/DS/ and http://duodenalswitch.com

Hi Kim, I am from Troy, IL, pretty close to you and just got done e-mailing Dr. Van Wagner in St. Louis. IF you have to be a self pay like I will have to be, they charge $14,800 if you have it done at Healthsouth in outpatient. This covers the Dr. fee, anesthesia, and facility fee. She also told me they do financing through Regions bank. The number is 877-527-2263 and then hit option #4. I hope this helps. Best of luck! Cathy H

Hi Kimberly! I have Bc/Bs of Kansas City Missouri and pay a pretty penny for it monthly but they would not cover it. It is an exclusion in the policy and they sent me a letter stating they would not cover it no matter what the medical necessity was......so I had to self pay. I think I would start with your own family physician and he/she has to recommend that you have the surgery then contact a bariatric surgeon. The surgeon's office will most likely have a seminar they want you to go to first and that is where you can get a lot of info. Well good luck! Hope things are going well with the job. Also forgot to tell you to be careful with the pre-exsisting condition clause. Most employers and insurances will have a period of time (some 1 month, 3 months, 6 months, or even a year) that they will not cover any thing or any treatment connected to a disease or condition that you had before you started on the insurance. Becky