BCBS of NE cover DS?

I am going to post this on the DS site too, but has anyone had any luck with BCBS covering their DS surgery?  I have the Wellness Options plan with the State employee's plan.  I'm getting tired of the runaround with the VSG not getting covered, so I think I'm moving on to DS.  Thanks!

Sarah

Hi Sarah !
I also work for the State of Nebraska. I am trying to get the DS and have been denied twice. I am on the final appeal. I had hoped that I would have it approved and done before our insurance changes on July 1st. Now I just hope it will be included in our new benefits. This is the information I have found.   This is what is listed in our “Guide to Your Health Care Benefits for Employees of State of Nebraska".   Surgical Treatment of Clinically Severe Obesity (Morbid Obesity). Surgical treatment is covered if al of the following criteria are satisfied: -The covered person is at least 25 years of age. -The covered person as a Body Mass Index of:             At least 40 for at least three years, or             At least 50 (classified as super-obese), or   Great than 35 in conjunction with documented treatment of a co-existing medical condition of at least one of the following:   Hypertension requiring medication for at least one year. Type 2 diabetes requiring mediation for at least one year. Obstructive sleep apnea, confirmed by a sleep study, which does not respond to conservative treatment, Cardiovascular disease, Pulmonary hypertension of obesity.   -The covered person has a documented history of failure to sustain weight loss with medically supervised dietary and conservative treatment for at least three years,   -The covered person is an acceptable operative risk,   -The covered person has been evaluated by a licensed mental health provider who documents that you are motivated to follow all necessary pre- and post-operative treatment plans.   Preauthorization of benefits are recommended prior to weight reduction surgery.   Morbid Obesity Surgery includes, but is not limited to stomach surgery (gastroplasty), stomach stapling (gastric stapling), stomach bypass (gastric bypass) or surgery for the removal of fat from the belly (panniculectomy and abdominoplasty).     People have been approved for DS in my office prior, but it has been a few years. I’ll cross my fingers for you and hope we both are able to receive this great tool. Let me know if I can offer any additional information to you.
Amy

Amy,

I had my meeting with Dr. Anthone this morning.  He said that BC/BS does recognize DS as a bariatric surgery, so I was hoping to get approved with no problems.  I hope they don't jerk me around with this the way they did with the VSG.  It's really irritating.  So anyways, I'll keep my fingers crossed for you if you keep your fingers crossed for me!  :) 

Sarah

I forgot to ask, what was their reason for denial?  Thanks!

I had not read our policy through the state, nor did I know where to find it. I have not had a BMI of 40 for the past three years nor did I have a co-mobidity. Now through testing, I have been diagnosed with sleep apnea. I hope that helps towards the appeal process. From what I listed above I am unsure due to not being clear what 'conservative treatment' means.

Keep pushing, one person had to go through the hearing process to get approved. I think they want to see how bad you want the surgery and if your willing to continue with appeals.

Let me know how it goes!!

Thanks for the info.  I am so frustrated with them making us jump through so many hoops, just to get the care we pay for.  I hope I get approved right away.  I'll let you know!

Sarah

Hi Sarah!

I was wondering how you are doing on your journey? Have you heard from insurance?

I just got approved on Thurdsay and has all of my pre op testing done today. Now I just have to wait for Dr. Anthone's office to call for a date.

Amy

Hey Amy!  I finally got approval a couple weeks ago, and have had the preop tests done, but am waiting for my PCP and Anthone's office to get coordinated with each other so I can get a date also.  I'm hoping tomorrow, but who knows.  Let me know when your date is... maybe we'll see each other in recovery!

Sarah

We have bcbs of NE through the State of Nebraska (my husband's employer) and I was approved within days of submitting the paperwork.  Hopefully it wasn't just a fluke and you'll be as equally lucky as I was.  I just celebrated my 1-year "surgiversary" yesterday! :)  I'm happy to say I'm down 124 from my highest weight and couldn't be happier about getting my DS.

Good luck Sarah!

Felicia

Woo hoo, Felicia!  You are doing awesome!  You are seriously an inspiration to me, especially since I've decided to go down the DS road.  I am going to call today to see if it has been submitted yet.  Also, good luck to you on your "personal" journey.  I know times are tough for you now, but I'm sending hugs your way.