Insurance question my Florida people

Hi I have Blue cross blue shield of Florida, State employees PPO. I'm being told on the phone by these people that WLS is excluded from my contract/plan and due to this is will not get approved. My question is has anyine else had this type of insurance and if so did they have and exclusion overturned with this specific insurance company. Because there telling me that even if a Doctor says its medical necessity that they still won't pay B/C of the exclusion. Now keep in mind I have an appointment with Dr. Gagner (WLS Surgeon in Miami) on Monday (3/3/08) and  I plan on talking with him about this and fighting this insuracne company, even if I have to get a lawyer invloved.  Please let me now fellow Floridians what you think my chances are with this. Thanks, Tiffany

I have the same insurance.  They cover everything except the DS. Look Here Good Luck!

I have State Of Florida - Avmed.  They pay and I have been told that BC/BS does pay.  Is your doctor with a Center Of Excellence? The surgical group that I am using, put everything through for me.  I did not even have to talk to the Insurance Company.  Who do you work for?  Lynne

If your policy exludes it, it's because your employer chose that exclusion.  Not every BCBS of Florida policy is the same.  The employer chooses what is excluded.  Just because someone else has BCBS of FL and was approved (as I was), does not mean someone else will; it's all about YOUR employer. Honestly, I don't know anything about fighting exclusions but I would be surprised if you won that one.  =(  Sorry!

If your employer did not buy the "rider"  aka its excluded----then its a done deal.. they will NOT cover it at all.. NADA... NYET...ZILCH.  

As of Jan 2005 BCBS of FL quit covering WLS unless the contract purchaser (your employer) bought the rider that covers WLS.

As far as I know, NO ONE has won against them at this time... thus why many people with BCBS of FL are self pay OR change insurances when their plan years is up... IF their employer offers other plans (mine didn't, one plan one size fits all--which of course it doesnt.)

This is about the bottom dollar... and cost cutting due to state budget cuts.   

Tiffany,  Do't loose hope there  is always a wa especially if it is Medically Necessar by yor Doctors and you just have tobe willing to fight it and even if you have to go with a lawyer there are lawyers that specialize inthat.  But there are some great letter's right here inOH site that will help you with that and for you to be able to send to the insurance company's an I know of another sire which s also great is http://www.bariatricedge.com/dtcf/pages/home.htm. this web site also has some great ideas for letter's and you coul research.  There is a Law that when it'sMedically Necessary by your Doctor's for you to have this surgery that  they will cover it. Sometimes i is modo forthe Insurance company's t deny you 1.2,or even three times hoping that you will not appeal until they have no other choice.  There is a great friend she is on this site and she has some great letters appealing o the Insurance Company look he up "Diva Princess" once you go to her link it will say her storyand even have the apeal letter's that she even got Plastics approved bythe insurce ompany after appealng it. Good Luck, My God Bless You. Esther A PS to be able to find the letter samples on this site jus tdo it by the search

I am a state employee and had wls w/ CHP in Tallahassee, which I'm told is owned by BCBS.  I don't know about the PPO. I see you are in Moore Haven- My mom grew up there... Hope you are successful in getting the insurance to cover your surgery.

Hi, I have bcbs of florida and am covered at 100% minus a 2100 copay. Hope that helps...

I have to agreee with SandyFeets. If your employer did not add it and it's an exclusion I don't think there's much you can do about it. I am on my husband's BCBS insurance through his employer and it's an exclusion. There was no fighting it. I had to self pay for my surgery. Good luck to you.

Hi- I have bccbs ppo- (we own our business, the rider was never offered to our company) and wls was EXCLUDED-  my surgeons office said no chance of coverage-  so i was self pay. i DONT regret it one bit, best decision i have ever made in my life.