Regence BlueShield of Washington

Well I just got off the phone with Regence BlueShield and they told me that they do not cover Gastric Bypass or anything that deals with weight loss surgery. I explained to them that I have type 2 diabetes, high blood pressure, sleep apnea, as well as lower back problems and painful feet joints that sometimes cause so much pain I can hardly walk. For all the above I am taking medication to help me. I am tired of being overweight, 340 pounds and a BMI of 45, that I need to do something. Now I do not know what to do now that the insurance company states they will not cover it. Anyone have any ideas about what I can do. I cannot afford to get a loan.

I'm sorry to hear of your difficulties and believe me I'm in no way backing the insurance company but the coverages are choosen by the employer so they are the ones that chose not to pay the extra to include WLS. So you might take it up with them and push for them to add the coverage. There are some places that give health related loans that might be an option. I wish you the best and that something will turn up for you.

Hi,

Insurance is such a pain in the you know what.  For the last few years I had Regence BlueShield with Boeing Selections plan.  They did not cover the surgery, but I found out that the Regence BlueShield Boeing Traditional Plan did.  So my husband and I switched over to that this past July.  I had read all the surgery approval requirements beforehand and they were pretty easy. 

When we changed to the Regence BlueShield Boeing Traditional plan this year, they changed the requirements and made it much harder.  I know have to go through 12 months of doctor supervised dieting with charting to make sure I'm capeable of loosing weight.  So now I have to basically start from ground zero. 

From what I have learned through all this is that Regence BlueShield has many, many different insurance plans and they do change all the time in their modications as to what they cover and what they don't.

You should be able to examine your exact plan and what it covers or doesn't cover over the Regence BlueShield website.  Get your policy number and group number and check this information out - or ask your insurance representative to send you a copy of this information in the mail - by law they have to do this if you request it - something I just learned.

If there is an exlusion on your policy find out if you can switch over to a different policy that does cover it.  Find out if you can do this now, or if there is a specific open "season" when you can switch over.

I'm like you, I can't afford this on my own either. 

In the meantime, go see your family doctor.  Have them document your height, weight, that you are interested in surgery, and discuss a diet plan with them (can be something as simple as low glycemic, Atkins, etc) and discuss some form of exercise - make sure your doctor charts all that!  Many insurance companies now require 6 months - one year doctor documented weight loss attempts showing a loss with no gains.  Start now.  Some insurance companies require a monthly weigh in with your doctor some require a weigh in every three months.  All are different.  Mine says I can also see a licensed nutritionist but that nutritionist has to be under a doctor's supervision.  Start now if you can.  If I had known all this a year ago when I first started checking out weight loss surgery - I would be getting my surgery about now.  However, now I have to jump through this 12 month dieting attempt crap and have to wait.  My 100 pound weight loss with weigh****chers 4 years ago wasn't good enough for them. 

I hope some of this information helps and I sincerely wish you the best of luck.  The process can be long and difficult - but what choice do we really have....

I have choosen Dr. Ki Oh as my hopeful surgeon for RouenY (I always misspell it).

Sincerely,
ragadolly

That sucks!! I am with Regence  too those dumbasses. I had to go self pay with a loan from my mother-in-law. It totaled $ 13,000. Fills are $150 each time which we charge. I went to Dr.Oh. I am sorry you can't get a loan. Thay is really bunk. Regence sucks for insurance. I'd switch if it wasn't my husband's work insurance. I hope you find an answer somewhere. I'll be keeping you in my thoughts.
hugs, Ravenwolf

Yeah it does suck.  I saw my doctor today and thought for sure that he would say no to gastric bypass.  However, he was all for it stating that he thinks that it is a medical necessity since I am 150 lbs overweight with a BMI of 45 and I have diabetes, high blood pressure, sleep apnea and cannot exercise due to bad ankles and knee joints.  He stated that after I see a cardiogist about a stress test that he will submit a request to my insurance that i need a gastric bypass due to medical necessity.  I wonder how Regence Blue Shield will respond to that?

They covered mine. I had it on May 11th, and I have lost 50 lbs. I would try again. Sounds like you were given incorrect information.

Hopefully they will respond positively. I was successful a couple of years ago in getting a breast reduction out of them. I was sure they would say no but my doctor supported it and I wrote them a personal, in-depth letter outlining all the problems I was havin due to size G breasts. They are a size A now but suprisinly it looks decent on me, not out of proportion with the rest of my body. I weigh 215 now. I am extremely happy with my results. I am hoping they might cover my tummy tuck when I am ready for it.. Best wishes to you and keep fighting!!!!!

hugs,
ravenwolf