Woundering about insurance....

Crystal W.
on 9/14/03 7:47 am - Parkersburg, WV
Hello everyone, I have seen the physician, the deit gal & have been to the psychologist. I am now waiting to see if they all select me for the surgery. My question is this... In the mail today I received a letter from my insurance company Blue Shield that said that they would not pay for the Physicians bill. Is this normal? Does this mean that they will not pay for the surgery? They stated that my claim did not say that the visit was medically ness. I am 5'6" and weigh 330# I have bad knees and a history of family illness. Also can you please tell me about the angel program.
Denise W.
on 9/19/03 4:16 am - Maple Shade, NJ
It sounds like the doctor's office didn't code the bill correctly before submitting it to B/C. Unless your employer has a specific clause written into your insurance denying any surgery for obesity, B/C is one of the better insurances for getting this done. I don't think you'll have a problem, but you might want to call B/C and ask them if they cover it. More than likely, they'll tell you yes, as long as it's "medically necessary". Then call your doctor's office, talk to a billing person and tell them to be sure to stipulate that on their bills to the insurance co. If B/C Tenn is anything like B/C Jersey, the basic requirements for approval (medically necessary) is the need to lose at least 100 lbs and have a BMI of 40 or higher. In some cases they want a couple of co-morbidities too - i.e. back and/or knee pain, diabetes, high blood pressure, high cholesterol, sleep apnea or heart issues. Just get all the right tests done, documented and you should be good! Good luck as your journey begins - you're in for a hell of a ride! Denise
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