BC/BS of Alabama PPO plan 320

I have my consultation scheduled for June 15th. My employer is in the process of changing insurance to the above plan on June 1st. Does any one know if this plan covers WLS if medically necessary? Misty

Employers "tailor" the different plans to their own desires, and budget. They can choose exclusions to the plan, or add amendments to offer more coverage. The only way for you to find out what is covered is to request a copy of your SUMMARY PLAN DESCRIPTION from your employer. Good luck to you, Roberta

I have BC/BS of Alabama I just emailed them today..... go to: www.bcbsal.org click: I'm a customer (even though you are not, I'd put potential 320 plan) quicklinks: email customer service. Got a response in about an hour! My plan is not 320.... but goes by the call letters to my husbands company. Yours may be different, but it is a start! They consider the band experimental and on my plan cover by-pass based on: 1. History and physical including any medical problems related to patient's obesity 2. Patient's recent height and weight measured in a physician's office 3. Condition of morbid obesity is of at least two years duration (must be documented in the patient's medical record) 4. Non-surgical methods of weight reduction must have been unsuccessfully attempted for at least two years prior to surgery (These weight loss attempts must be under a physician's supervision.)

I mailed a letter to BCBS AL about two weeks ago requesting that they send their qualifications, including co-morbids to me in writing. My plan is a 510 Blue Choice Preferred Care plan. I have been denied twice and am working on my appeal. I wrote to all of my doctors and requested copies of all of my medical records (amazingly enough, not only did they all provide them, but they did it quickly...I explained in my letter that I was requesting the information for the purpose of seeking insurance approval for bariatric surgery). I got the last of my records in this week and have started graphing my weight, BMI, blood test results, etc to establish not only my history, but trending. I have been doing extensive research online and offline and plan to include articles that I feel relate to my situation (from respected medical professionals, associations and/or institutions). My first denial was on the basis that my apnea was not bad enough to warrant WLS. The second denial was on the basis that my BMI has not been >40 for 2+ years. (it has been 39+ with co-mormids for 5 years, with the exception of two occasions where the weight loss was documented as being the result of medical illness (the first time I was in cancer treatment, the second was documented as when I had severe gastritis for over a week). For the past year, my BMI has consistently been 39.5...but apparently that didn't matter. I was also recently diagnosed as Hypothyroid, but have no idea if that would in any way be considered a co-morbid. I use 12 different prescription medications on a daily basis, 3/4 of which would probably not be needed if I were able to lose the weight I need to lose. I will also be undergoing diabetes testing in the next week or two since we pretty sure I am at the very least, pre-diabetic, if not diabetic. I realize my BMI is not as high as many others here. But it will be if something is not done. I have EXTENSIVE family history of Morbid Obesity and Diabetes (Type I and II). Heck, even at my size I am the skinny kid in the family. I see what is in store for me if drastic measures aren't taken. I would prefer lap banding over RNY (my view is that it is less invasive, less expensive and reversable and should be considered an alternative for those with lower BMI's especially since the weight loss tends to not be as great - on average - as gastric bypass), But there is not a surgeon in my area that performs Lap Banding and my BCBS AL is pretty darned adamant that they only cover RNY (when/if they do approve it). That is just my personal preference, but if I have to choose between having RNY or nothing, I will accept the RNY without hesitation. Lap Banding is no longer considered investigational so I don't see what the problem is. I am very interested in hearing about how others approach the appeals process. What all are you including? What all kinds of documentation are you gathering and/or submitting? I want to cover ALL of my bases. I want to show them that bariatric surgery is indeed warranted in my situation, that I am serious about pursuing every avenue available to gain approval, and have educated myself and am making an informed decision about my health/life. What I don't want to do is come off sounding hostile or antagonistic. When I was diagnosed with cancer four years ago, I learned that you have to be your advocate. That means educating yourself and fighting for whats right and knowing when/how to pick your battles. SWC (stepping down from my soapbox now)