exclusion or not?!?!?!?

karen_2007
on 5/28/07 11:42 am - Hamburg, AR
HELP!!! I am now in month 4 of my six month diet that is required by BCBS of Illinois. I have called the insurance company to make sure that surgery is covered and they said yes. I also submitted records from the last 24 months showing that I had six months of supervised diet (I was trying to get them to approve it even though the diet wasn't consecutive.). I was sent a letter stating that they needed more information about my diet history. Well, Saturday I received a book of our insurance coverage (they just sent it to us because the co my husband works for chose another insurance co as of March 1--the previous insurance co we had covered surgery, but the co my husband works for chose a policy that  excluded wls). The book states that they do not cover anything for weight reduction. AFTER ALL I'VE BEEN THROUGH!!!! What do I do now? Do I call insurance company to verify that or what? Please help!!!  Thanks so much, Karen
gary viscio
on 5/30/07 10:36 am - Oceanside, NY
RNY on 07/01/03 with
It's two different companies?   Did you get any notice that they were making this change prior to 3/1?
Gary Viscio
www.ObesityLawyers.Com
RNY 7/1/03  -166lbs
karen_2007
on 5/31/07 11:39 am - Hamburg, AR

The first insurance company we had was Regence BCBS of Oregon and that insurance company covered the surgery, but my husband's employer opted to choose a plan that excluded wls, even though Regence BCBS covered it. Now, as of March 1 of this year, we've switched to BCBS of Illinois(because another company bought out my husband's employer). They have told me that they do cover the surgery and that my husband's employer did NOT put an exclusion in the policy for wls. But I received a coverage booklet in the mail stating what our insurance now covers. It states that anything related to obesity or weight reduction is excluded. I've since talked to BCBS of Illinois and they said that they don't know why it's in the booklet that it is excluded because it is NOT excluded. Also, when I sent in my information to be approved, they asked me to send in more information to help them make a decision----they did NOT say that it was excluded and that I was denied for that reason. I just want to make sure I don't get approved and then have to pay out of pocket because insurance later decides not to pay. PLEASE HELP!!!

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