Question:
How far to prod a carrier for support?

My insurance, (PA BC/BS Pers. Ch). will supposedly cover WLS (I'm not popping the champaign cork till it's in writing!) But it does not apparently, cover the doctor visits before hand which go in to the company under a code for "Morbid Obesity". It makes no sense to me that they would cover the surgery but NOT the doc visits which lead up to the surgery. I've been thinking about fighting this or trying to but I can afford to pay the visits. It's about 4 of them at $130.00 each. On the one hand it seems like the least I could do but on the other it seems preposterious that they would be so arbitrary and the next person might not have the means to pay. What do you folks think? Waste of time or good for the cause?    — Carol M. (posted on June 2, 1999)

June 2, 1999
I don't think it is a waste of time at all. You are right there are a lot of people who could not afford that and not have the surgery because of the doctor's visits. Although, it seems though the visits could be calculated in the surgery. If the insurance pays for the surgery I think the visits within a certain limit should be included. Try anything once, what's the most they will say, No!! Oh well, nothing to lose but $520.00 to gain. Good Luck!!
   — Rhonda B.

June 2, 1999
Your insurance may be trying to see how serious you are about the surgery! Ask your doctor if the initial bills can be included in with the overall surgery bill and that your early payments can be applied to the overall deductable. This way both you and your insurance will be able to work together.
   — Judy S.

June 2, 1999
GOOD CAUSE $5000 is peanuts compared to what the insurance co. will have to pay for care of a morbidly obese person down he road. I just got three bills totaling apprx. $500 for the tests for pre op from BC BS PPO, in PA. They denied the claim. I called and told them this was for surgery and the surgeon would be sending paper work. Ten Min. later I got a call and they are resubmitting them. Sometimes all it takes is our being willing to put up with all the red tape involved. It is depressing but worth it in the long run. I"ll update my file when I know the outcome of them redoing my claim. Carol Talor
   — Carol T.

June 2, 1999
Hi, I don't see how the required pre-op visits can be legally excluded from coverage. They are as much a necessity as the surgery. I would fight it on that premise. Insurance companies will never give anything to anyone because they are for profit. It is great that you can afford it, but it would be worth a lot to those who can't to have the insurance company hear their unfair practice stated and documented.
   — [Anonymous]

June 3, 1999
Are the four preop visits with the bariatric surgeon, or are they for the preop screening, such as the GI endoscopy, cardiologist, psychiatrist, etc? My GI specialist asked me if I had heartburn/acid reflux (YES). That qualified his fee to be covered. For the cardiologist... Did I have shortness of breath and pain in my chest or throat? Insurance paid his bill, and the bill for the echocardiogram he ordered after he found a heart murmur that I did not know I had! The psychiatrist I expected to pay for myself, but in the end the insurance company paid it.
   — Deborah L.