Monkey wrench

FOund out today at work that they will no longer provide United Health Care, no more HMO....we will either have to pic BCBS (empireblue?) or Aetna. They offer 3 different plans for BCBS but I dont know for sure if they cover WLS. I called and spoke with a cust serv rep and tho he couldnt get too detailed he said they do cover it with medical necessity. I dont know how much tho. Im so upset over this. BCBS is more expensive the United anyhow over all...for premium and deductable. ....so no telling what they will make me pay for surgery. Im wondering, can I get tenncare to supliment my ins (not just for the WLS but overall) if I can afford the copays and deductable for BCBS? I dont really know how the ins stuff works so Im a bit lost on it. I just hate to go thru the hoops for this surgery and then be told my new ins in 2009 wont cover it.

I am so sorry that you're dealing with this crap too!  My company was sold and so we're going to have new insurance on 1/1 as well, only we have no idea at all what companies they're thinking about.  I'm trying to do everything I can to get approval and have surgery before the end of this year so that I don't have to worry about it.

I can tell you that while I've had this job I've had Aetna's HMO plan and it has been really great to work with.  They do cover the surgery and even allow for a 3 month program, in most cases, with your sugery center.

It's definitely easier for me to say this than it is to actually feel and believe it, but it WILL all work out and you WILL get to have this surgery that can give you back your life.  I'll join with you in positive thinking and prayer, and hopefully that will be enough.  Keep us updated.

Thank you....I did talk to my surgeons office manager and she told me at least one thing is the same...they require the 6 mo pre diet like im on already...so at least Ill be head in that respect. I just hate not knowing...and we wont have rep's from the ins companies at work to talk about it all untill next thursday. ......keeping my fingers crossed!

I agree with SuperChik, BCBS normally requires that you lose at least 10% of your excess body weight prior to being approvevd.  I had Cigna and I have heard others that had Etnea and they seem to both only require the six month doctor supervised diet.  However, ask every question you can because each plan is written different even with the same insurance company.  I hate that you are facing this, however who knows maybe it will be for a change.  Also, anytime you are looking make sure both the doctor and hospital are covered, because when I was originally checking into surgery, I had a center that was covered but my surgeon was not, therefore I had to  change surgeons and centers.  I am now so grateful, as I love Dr. Spaw and his staff!!!

Best of luck,
Shelia

PS

You may want to inquire about their coverage of plastic surgery with medical necessity, some policies write this out so you may not be able to be covered regardless of the medical issues you haveeee,.

Hang in there!  It seems we always jump straight to the worst possible scenario.  In fact, I hold the current Gold Medal in jumping to conclusions! LOL!!!

It could possibly be a lot better than it is, and you are already ahead of the curve.  Just ask every question that pops in you head.

Can't wait to meet you in October, it's gonna be a blast!

Scott