BC/BS HMO New Mexico

Has anyone had success in getting HMO New Mexico to pay for the surgery? I've been on dozens of diets throughout my 27 years, although non-were Doctor supervised. My BMI is 60+ and I'm pretty desparate for surgery. Also, can anyone tell me what the usual time period is for a surgery to take place. Thanks!!

Hi, I have BC/BS PPO and they paid for the surgery the first go round. I don't know if HMO and PPO are that different. I saw Dr. Fry in Set. of 03, sent the rest of the paperwork in Oct. of 03, BC/BS approved the surgery on Oct 25, 03 had my surgery on Dec 1, 03. So it it took a couple of months but I guess that really depends on how busy the surgeon is. Good luck with your insurance. Nina

thank you for the reply Nina!! Did you have to go to a Docor (PCP) prior to talking to the surgeon? Or did you just go to the surgeon and they helped you along? Thanks, Cory

HI CHARLES I HAVE BC/BS I HAVE BEEN DENIED, I HAVE GONE THRU APPELS, A GREIVANCE HEARING & NOW I AM GOING TO THE INSURNCE EXTERNAL REVIEW. THEY TOTAL ME THAT NO BC/BS OF NM WOULD PAY FOR WLS BUT I TALKED TO ATTNOREY TODAY HE SAID JUST DO WHAT THEY SAY & WELL GET APPROVED. I SURE HOPE SO IAM LIKE YOU I NEED THIS SO BAD. ALSO I WOULD CHECK YOUR INSUANCE BOOK TO SEE WHAT IT SAYS ABOUT OBESITY TREATMENT. COLLEEN

I just checked my book and it states, "This plan does not cover weight-loss or other weight-management programs, dietary control, or obesity treatment, including sugical treatment of morbid obesity." "Benefits are not available for: obesity treatment, including the surgeical treatment of morbid obesity." "This plan does not cover obesity treatment under any cir****tance, including surgical treatment of obesity and dietary or medical treatment of obesity." I guess that sums it up! 3-statements in one book! Colleen, is your insurance BC/BSNM HMO, or is it the PPO? They me be the same in their views of obesity treatment. If they're different then I will switch plans from HMO to the PPO. Thanks again for your replys -Cory

I have BC/BS HMO New Mexico also and it has the written exclusion policy about WLS and anything to do with weight loss.It seems just so unfair. I do have Medicare, tho, thru disabilities caused by my problems i.e. bad knees, arthritis, high blood pressure etc.....and I hope and pray that when I ever get this off the ground that they will pay. Looks like Insurance companies and the employers that retain them would rather pay for help and prevention of other diseases associated with obesity than to pay for the complications that goes right along with it. Also, HI Colleen, fellow Hobbsan.....Nice to see someone else from around here on this board. Hope everything goes alright for everyone and we can all end up on the "Losing Side" soon. Donna