Screwed by BCBS again...

Okay, I am really upset (seems like dealing w/BCBS has that effect on me lately). Anyways, I know I have an exclusion on my policy for WLS. However, now they are refusing to pay for my regular medical care because my primary diagnosis is morbid obesity! I went to the doctors last month for swollen glands and chest congestion. During that visit, I ended up discussing my weight concerns with my doctor. He referred me for a sleep study because I had the symptoms of sleep apnea. He also did blood work (for the swollen glands). Well, BCBS sent me an explanation of benefits where they are saying it is a denied service on my policy because I have an exclusion to any services relating to obesity or morbid obesity!!! I called my doctors office and they told me that anytime you discuss weight concerns in a visit, they can refuse to pay because of the exclusion! Yet to build a case for WLS down the road, I have prove morbid obesity and comorbid conditions as well as a medically supervised weight loss plan! So, what am I supposed to do now? How do I get around this or am I going to have to pay out of pocket everytime I go to the doctor now? Frustrated in TN Tammy

Call your physician and get them to resubmit your paperwork again with a different ICD-9 code. BCBS will pay for it. Tell your physicians office that your swollen glands did not have anything to do your being OVERWEIGHT but with you beign SICK!! Dumb A$$E$!! I have dealt with this before so I did that and BCBS paid for it. Good luck!!

Thanks Tissyroo. I did call my doctor's office and they told me they would resubmit the claim with a different diagnostic code but she said BCBS may question the change and request to see copies of the doctor's note for that visit. During that visit we did talk about weight loss, surgery, possible sleep apnea, etc. Soooo, she said they may read that and still refuse to pay for the visit. She said anytime you talk to the doctor about weight concerns he has to document that in the chart and BCBS is privy to that information. Oh well. We'll see what happens. I am going to tell the doc from now on not to use morbid obesity for my billing code and hopefully he won't. I just dont see how I can start to build a case history to prove morbid obesity and have a medically supervised weight loss plan w/o talking to the doc about these issues and have him document them for future reference, y'know? I am going to try to get another job with different insurance that might require these things for WLS. I think I am in a catch 22 here. I dunno. Tammy

These insurance companies are such jerks. If they won't pay to resolve the underlying issue (obesity), how in the world can they refuse to pay for the medical problems that are caused because they won't let you get the obesity taken care of? I would definitely take this to your Insurance Dept if they continue to pull this stuff.

Hey JH, You're right, these insurance companies are jerks. BCBS never did end up paying for my visit even after my doctor's office resubmitted the claim with a different diagnostic code because they requested the records for that visit and saw that we talked about weight issues. I am so tired of them screwing around with my health. I pay good money for my insurance (monthly premiums and co-pays) and I feel like I am being discriminated against. I have thought about hiring a lawyer to fight them but I really don't have the money to do that right now. I guess I am going to have wait and hope that something changes. For now, I am trying to look for another job with better benefits and so is my husband. There is also a bill in our state legislature right now that if passed, would make all insurance companies have to pay for WLS, so I am hoping that they will pass this bill and make it a state a law. So, we'll see. Well, sorry for rambling, it's just so frustrating. I don't know where you are at in your WLS journey, but good luck. Tammy