Road Block #1

I just called my insurance company. They told me that I have an exclusion policy for WLS. I have BCBS of TN, Network P. Needless to say, I'm a little sad right now. I felt like God had confirmed me to have this surgery and now I don't know what to think. What is my next step?

Hello Herriett, I am sorry to hear about your ins.i have bcbs of tenn.blue care i guess it is not the same.I also have a case manager with them i talk to that has helped me a lot.but with a exclusion i just don't know sorry i wish i could help more.good luck Eva:wave;

must be a company exclusion because i have bcbs network P

Harriett, I have that insurance too. I started this procedure over a year ago. I wrote the first appeal letter, it was denied. I requested a second appeal and went to Chattanooga in person(over 3 hours away) hopefully to convince them that I need this surgery. I have all my information, doctors letters, pictures, co-morbitites, and everything, I waited a week and then got the second denial letter in the mail. My last chance is arbitration. I have until Sept 1st to let them know if I want to do this or not. I DO NOT mean to discourage you. Even though we have the same insurance it could be different for you. All I know is we pay over $7000.00 a year for this crappy policy. They will treat a drug addict, but not a food addict. They will treat an anorexic and bulimic, but not a morbidly obese person. They will treat all your co-morbitities, but not cure them when they can. Go figure. All they want is your money. I am sorry about going off. I just really hate them for not covering this surgery. I wish you all the best. Nicky

If Joe is correct & it is a company exclusion. You can go to your Human Resources manager & ask if they will approve the surgery for a one time override on the exclusion for you. If you can prove medical necessity they may do this for you. I have heard of other people who have been successful doing this through their HR dept. Good luck to you. Greg

I did call BCBS back a second time to verify what I was told. It is a written exclusion by my husbands company. He is going to call the HR department for me today. They also have 2 other insurance policies available to their employees. He is going to look into them as well. He is going to see what HR suggests. Thank you everyone for the input on this. I will keep you posted.

Hiya Harriett. I'm sorry to hear about the exclusion. I'll certainly keep my fingers, toes and eyes crossed that your dh's company can make an exception, or that one of the other plans will cover it. Dont give up and keep on fighting. This is one thing thats worth the effort. God bless! Melanie

Harriett, I also have BCBS of TN, my card has "blue network P" on it. I am a state employee, it also has "PPO Plan-State of Tennessee" on the top of the card, I don't know if that makes any difference or not. I feel for you, I'm still trying to get approval (and have been since December) and my plan DOESNT have a WLS exclusion. Don't give up. I know it's easy to say and hard to do, but make sure you tell yourself, I WILL HAVE THIS SURGERY,,,no matter what, and work toward that goal. Good luck to you hon, and keep us posted on your progress...hugs, Carol

carol I am also a state employee and it takes a long time to get them to move on it. just keep at them. If I can help legally with anything just read through my profile and contact me. best of luck. Joe

I will pray for you as well Harriett. I agree with Greg to go to HR and see if they will override the exclusion. I have heard of people doing that. Hope everything works out for you. Tara