BCBS really hates me

I have BCBS of MI and have started their 6 month medical requirement.   I just received my explanation of benefits and it states that my contract doesn't cover the treatment for obesity so they aren't paying for my doctor visits, that they require.  Does this make sense?  I can't afford to pay $75 every month for the next five months to fullfill a requirement of theirs. Can someone advise me on what to do?

Ok so if i understand your post correctly. BCBS does not cover surgery for obesity.      ??        If that is correct you don't have to do the six month supervised diet unless your surgeon you chose requres it.  If BCBS is not going to pay for the surgery you dont' have to follow their rules........... And how could they have told you to do the six month diet if they were not going to cover the surgery........hmmmmmmmmmmm I would call BCBS to get clairification... And then talk to your surgeon..  Sounds like your on a self pay basis now.. so it is your own rules pretty much. Good Luck to you.. Michele

No, you misunderstood.  They DO cover the Lap Band surgery, provided I meet their requirements.  In following their guidelines, they don't want to pay for the doctor visits that THEY require.  It makes absolutely no sense to me. 

Each insurance company has their own guidelines. I have Freedom Netowrk~Construction Workers Laborers Fund, and they do cover WLS, (both RNY and lap-band) but will not cover any weight loss medications.  Since my insurance co. requires a psych eval and nutritional consult be submitted proir to determination, they will pay for the office visits, because THEY require it.  

I just finished my 6 month medically supervised diet/exercise program. I actually had to go 7 months, because BC/BS considers the first visit a consultation. My doctors office coded the visits something other than the treatment of obesity. I believe they coded most for the treatment of my thyroid disorder. One or two may have been depression, not sure, all I know is none got denied. Do you have a co-morbidity? Ask your doctors office to code the visit for the treatment and/or followup of one or more of your comorbidity, such as high blood pressure, diabetes, high cholesterol, etc, etc. etc.  Hope this helps! Good luck in your journey!

I have Highmark BCBS and they have similiar requirements, 6 month physician supervised diet. Our plan will not pay for the treatment of obesity, diagnosis code 278.00 but it WILL pay for morbid obesity, diagnosis code 278.01 so if your BMI is over 40 just make sure that when you go in that they code it as 278.01 I would also suggest calling BCBS and asking them to send you the portion of your policy that deals with WLS. While you have them on the phone ask them if your policy covers diagniosis code 278.01 and they should be able to give you a straight answer. They did not give me the run around at all and they promptly sent me the section of our policy that I needed. Good Luck.

Hi! I have the same exact insurance, BCBS of MI, with the same exclusion...in the exclusion section of my policy it says "therapy and hospitalization for weight control," which does not exclude the surgery, but they do not pay for nutritionist visits or visits to the doctor for the purpose of weight loss....I know, I was pretty frustrated with them, especially since my nutritionist charges $84 for 15 minutes, and I don't have the option to go to someone else! Are you having RNY or the band??

I am trying to have the lap band surgery, but running into roadblock after roadblock.   Thank you all for your responses.  I will ask my doctor to bill under a different code other than just office visit. -Traci

HI, I also have BC/BS of MI and they tell me I have to have 12 consecutive months.  Did you have a special situation where you only had to have the 6 months?  Do you know of any loop holes in the system for this insurance requirement? Thanks, Stacey

Hi Stacey, I've never been given any specifics on the timeframe from BCBS of MI.  I've asked them to send me something in writing stating exactly what I need and they said that they couldn't.  Who knows, it very well be 12 months that I'll need.  I won't give up though. -Traci