Denied By Blue Cross/Blue Shield
So I get a call from HUMC telling e what my deductible payment was going to be and that I should bring a check when I come into the hosptial to check in (my surger was scheduled for 3/26/10 which is tomorrow). I thought it was odd that I heard from the hospital before I heard from my surgeon so I called teir office and told them about the call I just got from the hospital.
I get a call back from my surgeons office and they tell me that my paperwork has been denied because my insurance policy doesn't cover bariatric surgery. Now, when I started this process I called BC/BS and asked if the surgey would be covered and they told me yes. My surgeon called BC/BS to make sure my surgery would be covered and they said yes, as long as I completed all the requirements.
I can't even begin to tell you how dejected and depressed I am now. All of the effort, time and money that I have put into this and now they tell me that policy does't allow bariatric surgery. I just don't understand how they can get away with this.
I have a copy of my insurance policy and nowhere in it does it state that bariatric surgery isn't covered. They also told me that it is considered cosmetic surgery.
I spent the entire day on the phone with BC/BS and got nowhere.
I get a call back from my surgeons office and they tell me that my paperwork has been denied because my insurance policy doesn't cover bariatric surgery. Now, when I started this process I called BC/BS and asked if the surgey would be covered and they told me yes. My surgeon called BC/BS to make sure my surgery would be covered and they said yes, as long as I completed all the requirements.
I can't even begin to tell you how dejected and depressed I am now. All of the effort, time and money that I have put into this and now they tell me that policy does't allow bariatric surgery. I just don't understand how they can get away with this.
I have a copy of my insurance policy and nowhere in it does it state that bariatric surgery isn't covered. They also told me that it is considered cosmetic surgery.
I spent the entire day on the phone with BC/BS and got nowhere.
Best -
Stacy
Stacy
I made contact with our benefits director last night and he is going to look into.
I have a copy of my company's insurance policy and while it doesn't say it's covered it doesn't say it isn't covered. There also a statement in the policy that states that weight loss procedures are covered morbid obesity has been diagnosed, that being a BMI over 40, which I do.
I just have to sit tight for a few days and await a response...
I have a copy of my company's insurance policy and while it doesn't say it's covered it doesn't say it isn't covered. There also a statement in the policy that states that weight loss procedures are covered morbid obesity has been diagnosed, that being a BMI over 40, which I do.
I just have to sit tight for a few days and await a response...
Best -
Stacy
Stacy
If your company's policy says that weight loss procedures are covered if morbid obesity has been diagnosed, then your weight loss surgery is a covered benefit. That fact that you had a BMI
over 40 makes it a covered benefit for you. Keep looking into this. Don't give up. If that language is in the policy than you have a legal .right to this surgery .
Janice
over 40 makes it a covered benefit for you. Keep looking into this. Don't give up. If that language is in the policy than you have a legal .right to this surgery .
Janice
StacyCap,
Firstly contact your Human Resource and/or Insurance company and see if you have an EXCLUSION in your policy to Baratric surgery. If they say NO, then YOU'RE IN GREAT SHAPE.
When you call the insurance company, SPEAK WITH A SMILE - tell the person who first answers the phone "while I know you're capable of doing your job, but can I speak to your supervisor because I keep getting inconsistent answers". The person on the phone, is usually first line and can't really help - HOWEVER you do get the one who knows THEIR SH*T - so if they are willing to go that extra mile, give them a shot. ALWAYS DENOTE THE PERSON'S NAME (they may only give a first name - ask for last initial or ID number), DATE AND TIME and highlight what they are saying. Before ending the conversation, highlight to the person what they said - then go back to either your HR office and/or Doctors office.
The best way to win battles, is to be armed to the teeth.
Good luck, and let us know how it turns out.
Firstly contact your Human Resource and/or Insurance company and see if you have an EXCLUSION in your policy to Baratric surgery. If they say NO, then YOU'RE IN GREAT SHAPE.
When you call the insurance company, SPEAK WITH A SMILE - tell the person who first answers the phone "while I know you're capable of doing your job, but can I speak to your supervisor because I keep getting inconsistent answers". The person on the phone, is usually first line and can't really help - HOWEVER you do get the one who knows THEIR SH*T - so if they are willing to go that extra mile, give them a shot. ALWAYS DENOTE THE PERSON'S NAME (they may only give a first name - ask for last initial or ID number), DATE AND TIME and highlight what they are saying. Before ending the conversation, highlight to the person what they said - then go back to either your HR office and/or Doctors office.
The best way to win battles, is to be armed to the teeth.
Good luck, and let us know how it turns out.
Good Luck on your Journey !!
Tom
“Nothing I will ever eat will give me the feeling I get as when I lose weight” The views expressed are based on my own experiences - and should NOT BE FOLLOWED IN LIEU OF DOCTOR’S ADVICE/INSTRUCTIONS. Only your Doctor knows your condition, and make sure you talk to them before making any changes to your diet
Tom
“Nothing I will ever eat will give me the feeling I get as when I lose weight” The views expressed are based on my own experiences - and should NOT BE FOLLOWED IN LIEU OF DOCTOR’S ADVICE/INSTRUCTIONS. Only your Doctor knows your condition, and make sure you talk to them before making any changes to your diet
I had the two risk factors and a BMI of just around 40. I met with my surgeon on Friday and he called me on Monday and said I was approved! I was so shocked because I felt I was on the cusp with the BMI. I had (still do) diabetes and sleep apnea. My weight was about 230 lbs. at 5'2". I think that every BCBS plan may be slightly different...go on their website and take a look at your plan and then call them and ask for a supervisor and tell them what you see. I believe there should be no preclusions unless your employer specifically wrote one in. I know that BCBS pays very little to the doctors/hospitals so maybe your surgeon's office doesn't feel the payment they are getting is worth it and won't continue to fight for you.
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