Help with info about Medicare approval to pay after BCBSAL has denied
Hello, I'm new here as a member and I have already posted this question/topic under a different message board. A very nice fella answered my question thouroughly as I asked it.
It's a little complicated and I didn't make my question very clear. So...
I have BCBSAL through my husband's employer. I am also disabled and receive Medicare A&B, they ALWAYS pay secondary.
I know for CERTAIN that bcbs is going to deny me just like everyone else.(What are we paying them for anyway?)
I only Just have a BMI of 35 and to my advantage I have a very long list of co-morbidities that meet their requirements. I DON'T have continuous, consecutive,weight management records. I DID start going to a nutritionist last July when My surgeon assured me that bcbs would not cover me without proof of a 6 month diet program. I had to stop seeing the nutritionist in mid September due to my Endo. finding a very bad case of insulin resistance. I was immediately placed on the "6 Week Modified Fast". Then I was slowly allowed to introduce carbs back into my diet. I was placed on 850mg of Metformin 3 times a day. I took the Metformin from Oct. to Jan. of this year. I was very malnurished and felt like I was dying. I had gotten to the point of not being able to eat at all. I had to stop taking the medicine. It was toxic to me like an allergic reaction over time.And Believe it or Not; I only lost about 7 lbs through all that. So I continued to the present time with just trying to eat a sensible diet and exercise when I can. But in the last 6 months I have been so sick due to all my illnesses and disability, that I have not thought to be getting documentation from my physicians on my weight and diet.
Well...the two nice ladies I spoke with at Medicare stated that I didn't have to have a consistant BMI of 35 over the past year. But only at the time of application process. They both said " It doesn't matter what requirements BCBS holds to, if you apply for the Lap-Band procedure and they deny you, Medicare will approve it and pay it."
What I'm wondering is; is that true? I'm afraid I'll find out that Medicare will only pay if you met ALL of bcbs requirements and were then denied.
This is what I need to know. It's killing me to just "trust" what those young women said over the phone. I'm paranoid that they didn't understand my question or they weren't paying enough attention while reading the Medicare requirements to me.
I'm sorry this is so long and drawn out. I always give too much detail.
I sure would appreciate any help you guys can give. Thanks so much,
Laura
Most Active
Recent Topics
My insurance will not pay for my excess skin that hang down to my knees
Hockeymom87 · 0 replies · 635 views
Hockeymom87 · 0 replies · 635 views
