WI state employees needed

I have been in contact with Leigh Mills, *****cently did a news story about a woman who had WLS, paid for by Badger Care. I advised her that, although Badger Care covers WLS, state employees don't have coverage for it. She wants to do another story on this, with a TV interview. Unfortunately, because my position requires undercover investigations, I am not allowed to do TV interviews (or I would do it in a heartbeat). Is there anyone in this same situation who would be willing to do a TV interview with her? She said that she would like to do what she can to get insurance coverage for everyone.

My husband is a former state employee. Two thoughts.... First: We were told by my dh's surgeon while he was on medical leave for a back injury to "let your insurance coverage run out. Apply for badger care and come back and see me". Honest to Goodness!!! Second... The Blue Cross Blue Sheild Coverage the state plan offers DOES cover WLS!!!! Good luck. Gala

Jody, I am a State of Wisconsin employee. Just wanted you to know that the State of Wisconsin does have one particular insurance program that does cover WLS. It's called State Standard. You pay a lot more for it than you do for the regular HMO insurance coverages. However, it *will* cover WLS. I sure wish the HMO insurance options covered it, but they don't. The State is not willing to be that generous with its employees, unfortunately. I had my WLS covered because I took the State Standard. I don't agree that we should have to pay more for insurance than the next employee, just so that we can have this procedure covered. However, I was willing to pay extra simply so that I could have my RNY. Nancy E. Eau Claire

I was just going to say this. I did the same thing. Unity would not cover my surgery but the State Standard plan will, so I switched. Surgery is March 1st.

Evidently, I am once again a day late and a dollar short. I did switch to the state standard plan, as of Jan 1, 2006. Unfortunately, after I switched I got the booklet stating that they will only cover WLS if you meet ALL of their requirements. One of the requirements they added is that you have to have tried Orlistat, which is not covered by Navitus, our pharmacy benefit. Out of pocket, this costs over $200 a month. I was willing to pay this if it would actually work, but my doctor refuses to give me a prescription for it because, according to him, it doesn't work. So, I am now paying 5X the price for my insurance and I still can't get approved for the surgery. VERY FRUSTRATING.

WHAT!?!?! Jody, that is horrible! The state is the as far as employee benefits lately! I wonder if you call DOA and to HR about it, if they can do something about that one requirement so that you would not need to take Orlistat since their own PBM (Navitus) will not cover it. Is Orlistat maybe one of those third tier drugs? The ones that you pay $35 per month for?? If that's the case then its worth it to try. If I were you I'd go find another MD who will give you a prescription for it, just so that you can this taken care of! But first, I'd contact HR to find out if they can do something to change this requirement. Nancy E.

Nancy, Thanks for the advice. Believe me, I am trying every avenue I can think of. As for Orlistat, it's not even a tier III drug. It is specifically excluded from any coverage at all...which means I would have to pay the full price. On another note, the FDC has approved this drug for OTC, and it should be available at a fraction of the price later this year. However, I don't know if the OTC version would still qualify for the insurance requirement.

I never tried Orlistat, and I was approved. I did try other weight loss drugs though -- mainly phentermine (not the phen-fen combo). Have you tried any sort of prescription drugs for weight loss? I was also on Zoloft and Topomax (off-label use for weight loss)

As I posted above...my dh was a state employee - currently on long term disability. I said BCBS.... Is that the same as the state standard plan? And I would be more than PO'd re: the med issues and not covering. It is infuriating!! I will soon be a state employee. And am so greatful that I've had surgery already ( I was offered a position on Thursday). Keep us informed on what is going on. I'm interested in knowing if there is a way around the orlistat issue. Hang in there. Gala

Actually, BCBS does not do the State Standard Plan anymore. They did until this year. Now it is handled by WPS.