Insurance help??

Hi there, I have been reading these forums and really get alot of information off of them. Please can someone please tell me how long you have to have insurance coverage before you can put a claim for wls? I am considering BC/BS. Thank you! Shawna

most bc/bs plans I understand don't cover wls. My BC/BS did because it was the federal plan for US government workers. It covered everything from the surgery but $100 because I got pre approval . My Dr., Steven Tersigni of Coos Bay, handled all the pre approval stuff. Both he and Bay Area Hospital were preferred providers for BC/BS. Before you sign up for any plan, look through their book to see what things are excluded. I know Kaiser pays but you have a lot of hoops to jump through before you get it. With me, I got approval in 6 weeks and only had to see a psychologist, who was very nice and recommended me for the surgery.. Diabetes and high blood pressure tipped the scales in my favor. the good news is that the surgery cured both of them.

I am looking into insurance companies and if anyone has a good one that isn't so complicated to get the surgery can you please let me know. I see that Blue Cross is pretty good.... HELP...... Thank you I hope to get to know you guys in here with stories of my own.

Hi Shawna! I am not sure who your employer is, but this can also make a difference in if you get approved. I will let you know that BC/BS in Oregon is VERY difficult to get approved through...they stall at every turn. I work for the state of Oregon and got tired of fighting a losing battle, since my employer had a written exclusion policy for the longest time...I guess it is changing somewhat for 2006...not sure how smoothly the transition will go, though! I decided to go with a provider who is tried and true...Kaiser Permanente. I have loved the support from their physicians and the program, while quite involved as to what you yourself must do to move through to surgery, is top notch. From physicians who know their stuff to great support groups, I am sooo happy I made this choice! No more doctors trying to talk me out of this, no more fighting ins. companies, and on my way to Living Life!! Hope this helps!

Oh, one more thing when I changed to Kaiser, I was accepted into their program at my very 1st appointment! I just told her what I had been through, the problems I was having and that I wanted to get Bariatric Surgery. Since you don't know the Kaiser program, the "hoops" are simply attending support group once a month, journaling food, excercise and feelings daily, attending a 5 week Weight Management course (1 day per week), calling the program head to tell her what you've been doing, what you've accomplished and asking her to set you up for appoints. with the dieticians, psychologist, and physical therapist (one at a time!), and finally, the entire team meets, reviews your case and weight loss progress (they generally want around 10% pre surgery), and you get your appointment with the surgeon! Ok, sounds like alot, but they want your habits to begin to change so you know what you are getting into! Some get their surgery in as little as 8 months, the average is 10-12 months, and some have been in the program for 2 years or more! It really depends on the steps you take! Again, good luck! Oh, and if this sounds like alot of time to wait, many surgeons these days require a phys supervised diet for 6 months before you get approved for surgery...sounds about the same time frame!

Thank you guys for taking time to answer my question. To the question of employment, I am self employed. So the options are kind of limited but I am going to look into Kaiser. I started the Atkins diet and have lost 12 pounds. It isnt to bad just a bit boring. My sister did the wls and she has no regrets at all. I am just SOOO tired of being fat. I have been heavy my whole life and have tried EVERY diet out there and I lose and then get bored and gain back. Atkins seems pretty easy to stay on though, I don't have the cravings like the other diets. But thanks again for your response. I am sure I will get to know you all in here I hope, It is such a great supportive place to be.

Shawna, Insurance coverage for WLS in Oregon pretty much stinks. Most companies work HARD to make it next to impossible to get coverage for WLS; and a lot of employers work right along with them to play right into that - they purchase insurance products that have airtight exclusions for anything relating to weight. I've been there/done that girlfriend! Got denied through BC/BS and ODS. I had five letters of medical necessity from different physicians and surgeons on my medical team - and still - pretty much told to take a flying leap. I sought out an attorney to help me fight the exclusions - but he very candidly (and kindly) informed me that I had no chance of winning - it would be money down the drain. He advised me to save my money and self-pay. It was some of the best advice I've ever gotten! Of course - easier said than done! LOL! But, thanks to a miracle - I was able to self-pay for my surgery. Taking control of that situation - chosing the surgery that was right for me, the surgeon I felt most confident in, and the timetable that worked for me was so liberating! Now - three years four months later - 210 pounds lighter, free of my wheelchair, diabetes, hypertension, sleep apnea, CHF, GERD, stress incontinence, chronic pain, etc., etc., etc.... well, I'm - well, thankful! - that the NW is insurance hell for those of us seeking WLS! I would have never found my wonderful surgeon, or had the courage to take a stand for the surgery that I truly wanted. Best of luck to you! Blessings, dina