Is there anyone who has BCBS of SC point of service? :help:

I have Dr. Sabback and he seems to be a wonderful person. He has been so nice to me. I have BCBS of SC POS and he has told me that he has had problms with that ins. co. before but we went ahead and did all of the pre-gastric stuff and BCBS paid with out question. Does anyone know if that means that they will not fight me on this? They have stated any proceedure pertaining to obesity will not be paid for in the exclusion part of the book,but then they pay for my pre-ops. I'm confused. anyone who knows anything please let me know. Even similar experiances w/ different ins. co. I also have medicaid. Maybe that will be a good push for them to pay something.

I have BCBS of SC ASO which operates similarly to the POS contract. When I contacted BCBS customer service to question whether my insurance covered bariatric surgery/tx for obesity, they replied that it was an exclusion or a non covered benefit. I don't know why but I decided to contact my employer's benefits dept to see if the bypass surgery was a covered benefit and behold it was. What a pleasant surprise! The benefit rep mailed me a copy of the coverage statement which I xeroxed and gave to my surgeon so that his nurse could include it along with the request for coverage. Three weeks later, I received an approval letter in the mail from my insurance company. I encourage you to contact your employer's benefits office and inquire. If it's not a covered benefit, ask who you can contact at your employer so that you can meet with them to discuss a request to get it covered. Oftentimes, the insurance company will cover a non covered service if the employer specifically asks them to. As for the preop services, I will assume that they were outpt and BCBS POS/ASO rarely require precerts for outpt services. If the service was below a certain dollar amount (like $10,000 for example), the BCBS computer will automatically clear the claim. If there is no recourse and bariatric surgery is not a covered benefit, then I would not rock the boat and point out to BCBS that they paid those specific claims for the preop procedures. Per their contract with healthcare providers, BCBS can request and receive their money back, thereby leaving you holding the bag & responsible for paying those bills. Best of luck to you!

I have BCBS of SC I'm not sure which one but it is through my husbands work. well I had a simular experience except they just flat out told me they weren't paying for anything having to do with weight loss surgery. I also contacted my husbands Human resource office to see if they could help and no luck there either. I got together with my family dr. gynogoligist and therapist all of them wrote letters on my behalf then I wrote one myself and explained the cost of my having a stroke or heart attack verses having this surgery. I then detailed my diet history with weight loss amounts and gains after I was finished with the diet. I then detailed madical history as to every problem I had dealing with my obesity and sent all of this to them. I got a reply in 3 days telling me to find a surgeon that everything was covered. I also have medicade too so I paid nothing out of pocket. I had my surgery July 1 and lost 80 pounds so far. good luck with BCBS.

OMG!! Do you have any copies of those letters that you sent? How much were you at starting this proceedure? I am so overwhelmed by this ins. thing that I am about to ask my husband to drop me from his policy for a year just to go ahead with the surgery. Thanks so much for the info!

I don't think I do have any of the letters but I can tell you what was in them. Talk to your family dr. first get him to write a leeter stating you need this for medical neccesity. if you go to any other drs. get them to do the same and just sit down and write the ins. and tell them that it would cost more for them to pay for a heart attack or stroke if you had one than to pay for this surgery and save your life. tell them about your life any kids how old you are, and how much you want to join life again as a much healtier person. let them know that you are determined to have this done to save your life let me know if you need anything else I will be glad to help.