Exclusion question

Sandy~Diamond
on 5/2/06 11:31 am - Somewhere In, WV
I know, weird question for y'all. Here's the story in a nutshell. As some of you know, I have the lovely CIGNA insurance. I just received my second denial. Well, I just found out yesterday that the company my hubber works for was bought. He announced that the insurance will be changing in 2 or 3 months! No more CIGNA Horayyyy!!!!!! BUT... will the new insurance have an exclusion? What will happen if it does? The new insurance will be Blue Cross/Blue Shield. I have seen good things about them from this site! Quick approval! Does anyone have a list of the states that have the law preventing them from making weight loss surgery an exclusion? If West Virginia is one of the states that says insurance companies can't make WLS an exclusion, I will feel a lot better about this change. Also, I don't know what to do about the 3rd appeal. Should I do it knowing they will be gone in 2 or 3 months and waste my time? I don't even know! Anyone had this happen to them before? Any advice would be welcome!!! Thank You!! Sandy~Daimond
shinmd
on 5/3/06 3:34 am - Charleston, WV
If you have BCBS via Mountain State (Highmark), they do cover Roux-en-Y gastric bypass. However, you must complete 6 months medically supervised weight management program with diet, exercise and behavioral modification. No WV is not one of the state that prohibits exclusion of bariataric surgery. If you have further quesiton, please call my office at 304-388-4965 or 866-788-4965. Also please check out website at www.camcwlc.org. Thank you. Robert Shin, MD,FACS Director of CAMC Weight Loss Center
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