Walmart BCBS???
Weight Loss Programs, Medications, and Aids:
Charges including medications, diet supplements, counseling (including nutritional counseling), and office visits for diet programs, appetite control,weight control and treatment of obesity or morbid obesity, including but not limited to gastric bypass, gastric restrictive or stapling procedures, or small bowel surgery to limit resorption, even if the participant has
other health conditions that might be helped by the reduction of weight. 
What is Not Covered by the Associates’Medical Plan
When I first called and questioned the person on the other end of the provider #, they told me that the doctor was in the network and so was the hospital... here's the clincher though when I called back with the procedure # though I was told that they do not cover the Roux En Y Bypass even though they have the doctor who does this surgery in network. I was told that I would have to talk to somebody at Wal-mart Benefits.
Such an interesting call this was. I was on the phone with BC BS speaking with David who said that he would connect me to Wal-mart Benefits. On a three way call, I spoke with a woman named Charlotte, told me that they only sign people up for the insurance and that I would have to talk to Blue Cross Blue Shield. When I explained to her that I already had and asked if David was still on the line, he responded stating that it was Wal-mart's call on this and not BC BS. Charlotte got very rude over the telephone and began disputing this with David and I was omitted from the conversation completely at this point.. only to listen to them going around and around. I finally ended the call explaining I was on my lunch hour from work and that I didn't have time to listen in to their bickering at that point. I wished them a good day and advised them I was disconnecting the call completely.
I proceeded to go to the Dr's seminar, but when the Dr's office tried calling, they received the same response.
Now... here is the other little deal. If you go to the Arkansas Blue Cross Blue Shield website to the FAQ's section, here is what it will tell you.
1. Do you cover gastric bypass?
Gastric bypass procedures require prior approval. To obtain prior approval, send provider's written request to:
Arkansas Blue Cross Blue Shield
Attn: Medical Audit and Review
PO Box 2181
Little Rock, AR 72203-2181
Fax: 501-378-6647
Wal-mart will tell you that they have no provider directory to provide to you at Wal-Mart Benefits. Also, they are overworked and understaffed. The majority of the people that they have handling your benefits have no medical training aside from perhaps some medical terminology and coding experience.
The other interesting thing to note is that in May of last year (2007), BC BS nationwide settled a class action lawsuit filed by 900,000 physicians just so that the doctors would receive what they were supposed to pay.
Obesity and Morbid Obesity are hitting the news more and more since most insurance companies do not want to pay for this. Aside from the State of Michigan, to even get the ADA (American Disability Act) to recognize this as an actual disease is difficult to say the least at this point and time.
Look at it from an insurance adjuster's point of view for someone with numerous medical issues that can be helped or completely rectified by having the Roux En Y Bypass. Diabetes and the supplies and medication along with doctor bills add up quite quickly and its an ongoing process year after year. The same with other conditions.
One would think that insurance companies would be willing to help pay the 25 to 35 thousand for this surgery knowing that their insured would be in better health than to constantly hike up premium rates year after year in order to cover hundreds of medical appointments or surgeries because of issues that developed in the insured; thus causing them to continuously pay more and more out financially to cover the insured's visits.
I do not accept this as a final fact that we cannot have the surgery simply because Wal-Mart dictates that we cannot.
Susan Chambers wrote a memo in 2005. Read on: Wal-Mart Memo Suggests Ways to Cut Employee Benefit Costs By Steven Greenhouse and Michael Barbaro The New York Times
Wednesday 26 October 2005 An internal memo sent to Wal-Mart's board of directors proposes numerous ways to hold down spending on health care and other benefits while seeking to minimize damage to the retailer's reputation. Among the recommendations are hiring more part-time workers and discouraging unhealthy people from working at Wal-Mart.
In the memorandum, M. Susan Chambers, Wal-Mart's executive vice president for benefits, also recommends reducing 401(k) contributions and wooing younger, and presumably healthier, workers by offering education benefits. The memo voices concern that workers with seven years' seniority earn more than workers with one year's seniority, but are no more productive.
To discourage unhealthy job applicants, Ms. Chambers suggests that Wal-Mart arrange for "all jobs to include some physical activity (e.g., all cashiers do some cart-gathering)."
The memo acknowledged that Wal-Mart, the world's largest retailer, had to walk a fine line in restraining benefit costs because critics had attacked it for being stingy on wages and health coverage. Ms. Chambers acknowledged that 46 percent of the children of Wal-Mart's 1.33 million United States employees were uninsured or on Medicaid.
Wal-Mart executives said the memo was part of an effort to rein in benefit costs, which to Wall Street's dismay have soared by 15 percent a year on average since 2002. Like much of corporate America, Wal-Mart has been squeezed by soaring health costs. The proposed plan, if approved, would save the company more than $1 billion a year by 2011.
In an interview, Ms. Chambers said she was focusing not on cutting costs, but on serving employees better by giving them more choices on their benefits.
"We are investing in our benefits that will take even better care of our associates," she said. "Our benefit plan is known today as being generous."
Ms. Chambers also said that she made her recommendations after surveying employees about how they felt about the benefits plan. "This is not about cutting," she said. "This is about redirecting savings to another part of their benefit plans."
One proposal would reduce the amount of time, from two years to one, that part-time employees would have to wait before qualifying for health insurance. Another would put health clinics in stores, in part to reduce expensive employee visits to emergency rooms. Wal-Mart's benefit costs jumped to $4.2 billion last year, from $2.8 billion three years earlier, causing concern within the company because benefits represented an increasing share of sales. Last year, Wal-Mart earned $10.5 billion on sales of $285 billion.
A draft memo to Wal-Mart's board was obtained from Wal-Mar****ch, a nonprofit group, allied with labor unions, that asserts that Wal-Mart's pay and benefits are too low. Tracy Sefl, a spokeswoman for Wal-Mar****ch, said someone mailed the document anonymously to her group last month. When asked about the memo, Wal-Mart officials made available the updated copy that actually went to the board.
Under fire because less than 45 percent of its workers receive company health insurance, Wal-Mart announced a new plan on Monday that seeks to increase participation by allowing some employees to pay just $11 a month in premiums. Some health experts praised the plan for making coverage more affordable, but others criticized it, noting that full-time Wal-Mart employees, who earn on average around $17,500 a year, could face out-of-pocket expenses of $2,500 a year or more.
Eager to burnish Wal-Mart's image as it faces opposition in trying to expand into New York, Chicago and Los Angeles, Wal-Mart's chief executive, H. Lee Scott Jr., also announced on Monday a sweeping plan to conserve energy. He also said that Wal-Mart supported raising the minimum wage to help Wal-Mart's customers.
The theme throughout the memo was how to slow the increase in benefit costs without giving more ammunition to critics who contend that Wal-Mart's wages and benefits are dragging down those of other American workers.
Ms. Chambers proposed that employees pay more for their spouses' health insurance. She called for cutting 401(k) contributions to 3 percent of wages from 4 percent and cutting company-paid life insurance policies to $12,000 from the current level, equal to an employee's annual earnings.
Life insurance, she said, was "a high-satisfaction, low-importance benefit, which suggests an opportunity to trim the offering without substantial impact on associate satisfaction." Wal-Mart refers to its employees as associates.
Acknowledging that Wal-Mart has image problems, Ms. Chambers wrote: "Wal-Mart's critics can easily exploit some aspects of our benefits offering to make their case; in other words, our critics are correct in some of their observations. Specifically, our coverage is expensive for low-income families, and Wal-Mart has a significant percentage of associates and their children on public assistance."
Her memo stated that 5 percent of Wal-Mart's workers were on Medicaid, compared with 4 percent for other national employers. She said that Wal-Mart spent $1.5 billion a year on health insurance, which amounts to $2,660 per insured worker.
The memo, prepared with the help of McKinsey & Company, said the board was to consider the recommendations in November. But the memo said that three top Wal-Mart officials - its chief financial officer, its top human relations executive and its executive vice president for legal and corporate affairs - had "received the recommendations enthusiastically."
Ms. Chambers's memo voiced concern that workers were staying with the company longer, pushing up wage costs, although she stopped short of calling for efforts to push out more senior workers.
She wrote that "the cost of an associate with seven years of tenure is almost 55 percent more than the cost of an associate with one year of tenure, yet there is no difference in his or her productivity. Moreover, because we pay an associate more in salary and benefits as his or her tenure increases, we are pricing that associate out of the labor market, increasing the likelihood that he or she will stay with Wal-Mart."
The memo noted that Wal-Mart workers "are getting sicker than the national population, particularly in obesity-related diseases," including diabetes and coronary artery disease. The memo said Wal-Mart workers tended to overuse emergency rooms and underuse prescriptions and doctor visits, perhaps from previous experience with Medicaid.
The memo noted, "The least healthy, least productive associates are more satisfied with their benefits than other segments and are interested in longer careers with Wal-Mart."
The memo proposed incorporating physical activity in all jobs and promoting health savings accounts. Such accounts are financed with pretax dollars and allow workers to divert their contributions into retirement savings if they are not all spent on health care. Health experts say these accounts will be more attractive to younger, healthier workers.
"It will be far easier to attract and retain a healthier work force than it will be to change behavior in an existing one," the memo said. "These moves would also dissuade unhealthy people from coming to work at Wal-Mart."
Ron Pollack, executive director of Families U.S.A., a health care consumer-advocacy group, criticized the memo for recommending that more workers move into health plans with high deductibles.
"Their people are paying a very substantial portion of their earnings out of pocket for health care," he said. "These plans will cause these workers and their families to defer or refrain from getting needed care."
The memo noted that 38 percent of Wal-Mart workers spent more than one-sixth of their Wal-Mart income on health care last year.
By reducing the amount of time part-timers must work to qualify for health insurance, Wal-Mart is hoping to allay some of its critics.
One proposal under consideration would offer new employees "limited funding" so they could "gain access to the private insurance market" after 30 days of employment while waiting to join Wal-Mart's plan.
Such assistance, the memo stated, "would give us a powerful set of messages to use in combating critics. (For instance, 'Wal-Mart offers associates access to health insurance after they've worked with us for just 30 days.')"
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So, what Susan is saying is that her benefit plan to us is so generous and she discourages the hiring of unhealthy workers but they will not allow a surgery that will give Wal-Mart employees or their families covered by these policies a chance to become healthy. Such the double edged tongue speaking there. Keep on pressing for this to happen. You and I and many others with this insurance have the right to be healthy. We have a right to not be excluded because somebody like Susan Chambers who has NO medical degree at all decides that this is not something that should be an option. Arkansas Blue Cross Blue Shield as a whole has criteria that you must follow in order for it to be covered; but, you must appeal appeal appeal and fight for your health... fight for your life. Good luck with yours and I will keep updating on my side as well. God Bless, Leslie
Hockeymom87 · 0 replies · 605 views
