discouraged

Well, I have contacted my insurance provider and they sent me a list of requirements. It appears that I do qualify, but after the seminar last night the program coordinator said that BC/BS normally asks for 6 months of monthly check ups. BC did not state that in the email I received from them. I get checked every 4 -6 months, complete bloodwork, weigh in and the general fussing. I was so encouraged that BC did cover weight loss, now I am down. I have an appointment with my PCP next week so I guess I will begin my 6 monthly checkups......(BY the way, mine is BC/BS POS, for state employees). I have an appointment for the surgical consult this month, but it seems useless now. Is this the way these things normally go? Any of you ever heard of BCBS approving w/o the six monthly checkups?

Hi Lisa, don't be discouraged. Honey, see your surgeon, but yes BCBS requires a 6 month Dr. Supervised diet just prior to you have the surgery. This way during the six months, you will be able to get all the requirements done, that your insurance wants and what your surgeon wants. Then you will be all set to have your surgery. Who's your surgeon? So keep your chin up and remember why you are doing this, you can do it. We all have faith in you, and you will succeed. Plus remember that whatever weight you lose over the next 6 months will make it easier when you have surgery. That weight coming off will be added to the weight you lose after surgery. May God travel with you on your new journey. Kathy

Hi Lisa, I would call your insurance provider and ask for clarification of the email they sent you. The program coordinator was probably speaking in general terms not having your specific plan details and paperwork in front of her. Remember it's what your insurance company tells you versus a busy PC trying to answer all the questions thrown her way at the seminar. I know that there are many different BC/BS and each have different plan requirements. I asked my insurance company to fax me a copy of their WLS policy so that I knew exactly what the requirements were. At my previous job, I had Blue Cross Blue Shield of MN and at my present job I have Anthem Blue Cross Blue Shield. Lisa - Good luck in your process. As someone who is still in the waiting period to hear back from insurance myself I know how easy it is to get discouraged, however these bulletin boards are the perfect solution for a dose of encouragement!

I know, I know I should be happy they cover WLS, but it is disappointing. I will try to look on the bright side. I will call and talk to someone personally at BCBS and document the coversation and who I spoke with. I should feel blessed my sister never could get her insurance to pay before her surgery, she waited over a year, and jumped through all of the hoops and they still denied her. She finally refinanced her house and had the surgery. 6 months after the surgery, they finally agreed to pay a portion of it, so she got some back and they agreed to pay for the fills. So, I will go one month at a time and have my doctor write a letter of medical necessity along with my records each month, wear them out with paperwork and maybe that will help. They also want proof of 5 years of morbid obesity.....this is a problem, I have been severely over weight for years, just morbidly over weight for 2, but I have several co-morbidities, fatty liver, high chlolesterol, insulin resistant, osteoarthritis, hip and knew pain, maybe they will waive some of the time due to this, I will keep my fingers crossed.

I have BC/BS of TN and no requirements for me. I just documented everything, had all my paperwork together and was approved in 3 days!! Double check with your provider and even after doing that, do not accept what they say as truth. I did not even call them. I sent in my paperwork to Dr. Houston's office, they sent it in and I was approved. It was amazing!!! Good luck and DO NO GIVE UP!!! Bryna