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Anyone get coverage with BCBS of MO (PPO)insurance??

jillicardi
on 3/22/06 9:12 am - owensville, MO
Six months ago I called my insurance company and asked about bariatric surgery coverage and was told that as long as it was medically necessary, it would be covered. My doctor is ready to get the ball rolling for me to go ahead with the surgery now because I have been diagnosed with diabetes. So, I called my insurance company today and was told that they have a written exclusion and do not cover any type of weight loss surgery. The weight loss center told me that others have been covered with this insurance. I am really confused. Anyone ever deal with this type of problem?
bransonboy
on 3/22/06 9:37 am - Branson, mo
You need to find out if your particular policy has an exclusion for weight loss surgery or not. If the policy has an exclusion they will not pay, it wls is not excluded in your policy they should cover it. If insurance wont cover wls capital one has financed surgery for some people, others have gotten home equity loans or borrowed from relatives. Medicaid and medicare also cover wls.
jillicardi
on 3/22/06 1:35 pm - owensville, MO
Thanks for the response David. Actually, when I contacted my insurance company 6 months ago I was informed that if there was a "medical need" for the surgery along with a letter from my doctors that they would review it; that it was handled on a case by case basis. Today when I contacted them, they did say that there was a written exclusion prohibiting wls. The coordinator at the wls facility told me that they would cover it, as other patients have had the same insurance and since I am a diabetic, there should be no problem. I guess all I can do is have them submit the paperwork and find out. I am hoping for a good outcome. Jill
shonnajo
on 3/30/06 1:11 pm - Neosho, MO
Jill I am going through the exact same thing with BCBS of Michigan. PPO. I called several times and they said it was covered and both times we called today they said there was a exclusion. I am having a hard time getting them to send a summery of benefits or certificate of coverage. Also the HR office where my husband works have no idea either. Please let me know if you figure out how to deal with this and I will do the same. Shonna
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