Blue Cross Blue Shield of SC (PPO)

I just spoke with my insurance company and found out that I have a contract exclusion for any weight loss surgery or complications thereof. What exactly does that mean?

Unfortunately it means that your policy specifically spells out that it will not cover any kind of WLS surgery or if you have the surgery on your own and run into complications it wont pay for the complications. My advice is to dont give up. If you have Blue Cross through an employer, you may ask the employer if they would be willing to help get the surgery authorized "out of contract" (meaning that Blue Cross would make a one time exception to their "will not pay" policy and pay it for you. Make sure you have the support of your physician and he can give you a letter to show that its medically needed and your previous weight loss attempts. Also, you can try sending a letter into blue cross appealing the policy with all the documents from your doctor(s) proving medically necessary. Customer Service should be able to let you know what the appeal process is. These are just my opinions. I hope that you can find something that helps. This website gives alot of feedback on what people have been doing to get approved so make sure you look around and read what other people have done. DONT GIVE UP!! Be persistant!!

We also have BCBS and I found out something. Some companies that are self insured use BCBS as a 3rd party for paperwork, They are not goverened by the insurance division of the U.S. Only by the Labor board. We have BCBS but it is sent to Central States for appeals. This in our case is UPS and the insurance is goverened by the union. I doubt the cases ever see a medical board at all. See if your employer is self insured-- and they don't like you to fiind out either. If you want to contact me my e-mail is [email protected]