state merit ins anyone?

i would be gratefull to anyone who could tell me if state meritt covers wt loss sx. for morbid obessity. and if so what hoops should i prepare myself for? thank you so much

Vicki, I am covered under my grandmother's state merit insurance and believe it or not there weren't that many hoops that I had to jump through. I completed the forms that my bariatric coordinator had, submitted as much documentation as I had, and she did the rest. The first thing to do is to make sure that it is still covering it. I began the process and was approved in November, but from what I understand BCBS of GA (state merit) was going to become quite selective towards the patients that they were going to approve it for. I would check with your provider. But as far as "hoops" there weren't any! If you have any other questions about my experience you can email me. Good luck, Nicole

I have state merit insurance and it does NOT cover any weight loss alternatives. I am switching to BCBS Blue Choice HMO which does cover the surgery in my county. Good luck. Your grandmothers insurance book should tell any exemptions. Mandy

make sure that your BC/BS hmo is telling you the facts- from what Georgia BC BS told me, they will NOT be covering WLS anymore at all after january 1, 2005 unless the company you work for has a fiscal year (insurance open enrollement) after then. Mine is July 1st (when insurance policy changes take place) so, surgery will be covered through June 30.

I too have state merit Cigna HMO. I initially had state merit PPO and they told me no way would they cover. The summary of benefits say that the PPO, PPO Choice, and Indemnity plans do have an exclusion that is why I went to the HMO. Now the HMO has denied me based on not medical covered. This has happened right in the middle of the plan year. I know several people that were approved in December and some this year using the HMOs. But I personally am appealing mine due to them trying to change my insurance in the middle of the plan year when they approved everything for the surgery in November and December but when the paperwork was sent in they denied within 5 days. If you get on the phone and call you hear so many stories you don't know what to believe. good Luck to you.

I'm a teacher with BC/BS state merit- having surgery on May 23. As of January 1, 2005, they do not cover WLS. If you are about to have surgery and your open enrollment has not happened yet, you'll be ok- (thats how i lucked out)...other than that, from what they told me- they will not cover it. period.

I also have State Merit Insurance. The policy I have has a written exclusion for any weight loss surgeries. I was informed that since I work for a school system that it all depends on the policy that your county choose to purchase. Most of the State Merit PPO policies will not cover it but the HMO's seem to cover it. Therefore I am praying that my husbands insurance will cover mine. I am still waiting on that decision at this moment. I do hope that your policy doesn't have a written exclusion. Will be keeping my fingers crossed for you. Patrice Rogers