BCBS - Appeal

I have a question. I'm currently covered by BCBS and in my booklet it states they will not cover anytype of weight loss surgery. Is there any chance I can get this appealed? I'm in need of it for obvious health reasons. I can get a letter stating such, etc. Has anyone had an exclusion in the policy but some how got the surgery paid for? If so, how?

HiAshley, I have bc/bs and am one step in front of you. I have an exclusion also and my PCP tried and they will not budge. Now bc/bs federal will cover wls,for an example, if you work at Tinker, HUD or places of the such. So so sorry.....I cried for many days but am now looking at selfpay (don't fall over) in Mexico. There are a couple really good dr. and the surgery is only 8200 to 11,000 compared to 17,000 here in OK. And money is obviously a concern for me. Good luck, Robbin

Thanks. I figured as such, but just thought I'd ask. I'm going to look into some individual insurance as my husband owns his own company. If they doesn't work out, I'll be forced to do the self-pay thing as well.

There are a few Insurance companies that are still covering WLS on small group policies with medical necessity. However, I don't know of any individual policies that will. In the state of Oklahoma, to qualify as a small group you only have to have 2 employees that work an average of 24 hours per week and are considered full time earning W-2 wages or partners and providing a partnership return. I hope that helps. I have been in the insurance industry for 11 years, so I have a lot of experience with setting up small businesses. Let me know if you need any advise. Sherry Gates High

I also have BCBS, with an exclusion. I ended up being a self pay. The cash price at Southcrest at that time was $22,500. I checked into more Dr.'s and found Dr. Baker in Little Rock, Ark. and the cash price there was $12,000. It's been well worth each cent I paid. Dr. Baker is the best in my book. Lorinda

Lorinda, Which procedure did you have? That seems really low for RNY!! did you have a Lap Band? Just curious. Either way it seems to be working great for you, so a great decision for sure. Sherry