Urgent - re: Insurance and future WLS approval

Posted on 02/03 03:16 PM by my WLS surgeon, Dr. Barry Haicken. Dear Friends: As promised, here is the name of Chief Executive Officer of Blue Cross/Blue Shield of Fla.: Robert Lufrano, M.D., Blue Cross and Blue Shield of Florida, P.O. Box 1798, Jacksonville, FL 32231-0014. He sent me a notice of Exclusion of Coverage for Morbid Obesity Surgical Procedures. The effective date is Jan. 1, 2005. They are obviously running up a flag to see if there will be an outcry of anger. There should be. They are simply washing away a major health care issue, and saying that they will no longer pay for the ONLY option which works for this disease. There is a great deal of prejudice against obese people. Nobody will stand up for YOUR rights. Folks, if you don't make noise, nobody will. Please write to this fellow often and be aggressive. Tell your friends. Spread the word on the internet, at work, at meetings. BC/BS pays for this surgery in New York, Calif, Ohio, Alabama, and on and on. BC/BS of FL is simply trying to save money at the expense of YOU and your health. They claim to be a non-profit, but clearly this is financially motivated behavior. Many insurance executives feel (or at least state) that obesity if a life style decision - not a disease. They suggest that obese patients simply diet and exercise..."it's easy, if you are motivated". It is proven that once the BMI is over 40, diet and exercise will not work. Surgery is the only proven, effective treatment for long term, significant weight loss. Please write and be active, All of the other insurers in Florida are watching the response to Blue Cross's initiative. No uproar, and they will all follow, thus effectively denying the morbidly obese of important insurance coverage. Sincerely, H -- Barry Haicken

THIS IS SIMPLEY AN OUTRAGE We can't let them do this to us. How can these people look themselves in teh face and call themselves human!@#$%^ !!!! I will be spreading it IMMEDIATLY!

Unbelievable!!!!!!!!! I will certainly do my part to make sure my voice is heard. I was just approved by UHC with an exclusion in my policy for WLS. Color me surprised, I had an appeal letter all typed up and ready to go the minute I recieved the denial. I believe it is true, the other Ins. companies will follow suit if BCBS gets away with what they are trying to do. and HOW IGNORANT of them to say DIET IS EASY WITH MOTIVATION...........YOU KNOW THAT PERSON NEVER HAD TO WATCH WHAT THEY ATE A DAY IN HIS OR HER LIFE!!! That would actually be funny if it didn't **** me off so much! Lets get on it WL family, we need to make some noise!

Wow! You were approved!!! How awesome! I am also UHC Choice Plus and I got a call from their nurse *****views the cases---I was denied, because there is an exclusion in my policy. My employees are willing to make an exception to my exclusion ---but UHC has YET to tell them the appropriate paperwork to fill out. They haven't called my employees yet---but we were told months ago, once my paperwork got to UHC, they would call my insurers and get the paperwork done then. But now: I get a nice little denial letter and I can, of course, file an appeal--then they'll tell my employers what to do to cover my surgery!! How many hoops do we have to jump through for them to do the right thing?! I am so glad that you got the surgery covered. I'll be using Dr. Murr here in Tampa---soon, I hope! Wish me luck; as I wish you only the best!!!

Dear Georgina, After reading your post, I did some research into the "facts" concerning insurance approval since I am considering WLS. I called Blue Cross and was advised that as of 1/1/04 ALL insurance companies are requiring that WLS applicants have documented proof by a medical professional of weight loss efforts for 12 consecutive months. Those medical records will be required by the insurance company before considering approval. The way it was put to me is that it needs to be documented that you tried one method of weight loss, then failed; then tried another one, then filed; then tried another one, then failed, so on and so forth until ALL methods of weight loss have been exhausted. Like I said, the foregoing began January 1, 2004 for all insurance companies. Also, the documenting of weight loss efforts must have begun prior to January 1, 2005 because as of January 1, 2005 all applications for WLS will be excluded regardless of the reason. Donna

I don't know how BCBS can speak for every other insurance company, that seems a bit outrageous. What is covered in your insurance policy is set by the package your employer (or whoever is paying for the benefit) chooses. Everyone has told me UHC stopped covering this procedure on 1-04, but that's simply not true. My UHC policy still covers WLS -- it depends on your employer (or whoever) contracts with the insurance company for coverage. They decide together what is or is not covered based on how much the employer can or wants to spend. Every person needs to read their policy carefully and see if it is covered or if there is an exclusion. My profile states what my surgeon requires of me to turn over to the insurance company. But, a friend of mine who works for the same company I do was just approved for WLS and told me what my company requires, a psych consult, a nutritionist consult and a diet history -- along with all of the documentation of medical necessity. ~ T.

It makes no sense to me that BCBS would be speaking for all insurance companies in Florida. Lynda ME/FL

I had BC/BS of Florida and it was covered as long as it was medically nec. Since then though my husband's Insurance has changed to Cigna/POS and I rec'd a notice that as of 2004 that it will no longer be covered for Florida (and three other states). I called the Insurance company and they stated that it depends on the plan the company choose. I was happily surprised it was based on "medical necessity". Now I am waiting approval from my Ins. I will write to BC/BS anyway just to have a word regarding the risk of surgery compared to risk of health problems due to fad diets or unknown weightloss perscriptions or over the counter drugs.

Thank you so much for the information.... I too have been "ostracized" by BC/BS of Florida. I just sent a letter off to them this week in fact regarding their treatment of their policy holders. I didn't have the name you suggested, but will send a copy of my letter to him tomorrow. [email protected] Lou Parsons

Dear Lynda, Georgina, and others: After receiving Lynda's post regarding whether or not BCBS can speak for other insurance carriers, I agree. However, one rep did speak for all of them, and another rep just didn't know. But the second rep did say AS FAR AS BCBS IS CONCERNED, AS OF 1/1/95 NO OBESITY SURGERY WILL BE COVERED REGARDLESS. And, as of 1/1/04, 6 consecutive months of doctor supervised weight loss efforts must be recorded BEFORE the insurance company will consider approval, NOT 1 year as previously stated in my earlier email. Regarding my present policy, it states that obesity surgery is excluded, unless proven medically necessary. BUT AGAIN, as of 1/1/05 BCBS will NOT pay for the surgery. Given all of the above and given the extensive research I have done about the way one has to live post-operatively, I have nearly decided to forego surgery and SERIOUSLY change my way of eating. I have become too frightened of complications and lpossible ong-term problems. I do not believe this is the way to go for me. I hope I am making the right decision -- I did pray on it!