Question:
I have BMI of 45 but insurance will not cover bypass is there help out there?
I seriously Need to have the bypass done because of health reasons but, bcbs of fl will not cover the procedure and I have no idea what to do. Anyone else have the same problem? — googley4me2000 (posted on February 19, 2009)
February 19, 2009
Cindy, I don't know the laws in Florida but if I were you, I would sit a
write a long, detailed letter to a Case Manager & enclosed a copy of
medical records reflecting your health issues. They're being plain old
stupid in not covering it because in the long run, because of your health
issues, they'll have to pay more whereas if they approved the surgery,
you'll begin to get healthy, saving them tons of money. If you really want
this, fight for it & write them a letter. I pray they change their
minds. If you need any further advice & simply want to vent, I'm here
for you.
Ruth
— Ruth M.
February 19, 2009
You deefinately want to appeal the decision. I know with blue cross here
they will send a letter of denial with a list of things to do. Once they
are done they will approve the proceedure. It is fairly routine for them to
deny the first claim submitted. Keep up the fight.
— trible
February 19, 2009
another option is that you can pay for the surgery yourself. They make it
(relatively) affordable in many hospitals in the US, and it's even more
affordable outside of the country.
— slimcolagirl
February 19, 2009
First, you need to find out WHY they denied your surgery. BCBS is notorius
for denying people. Even though I had seen my PCP for "physician
assisted weight loss" for 18 months, they still denied me. My
insurance requires 6 months supervised weight loss with the doctor, BUT
they won't pay for those doctor visits! So, my doctor got tired of billing
insurance, only to be denied payment. I just started paying him upfront.
Well, then when I went to have surgery, they said they had no record of
paying for doctor's visits. I was able to have my PCP write a letter to
the insurance company, stating my medical need for the surgery and how long
I'd been seeing him for my weight. Low and behold, I got an approval
letter the very next week.
My point to this story, is...find out why they denied, and then fix the
problem however you can. If your plan doesn't have wls coverage at all,
then you have no choice but to pay for the surgery yourself. If that's the
case, you can contact your surgeon to see if the accept CareCredit. If
they do, you can apply for the CareCredit loan, and go ahead with the
surgery, making monthly payments to CareCredit to pay for the surgery.
Best of luck to you. I hope you're still able to get your surgery.
— [Deactivated Member]
February 19, 2009
I hate insurance companies and the games they play. Appeal their decision
and I'm sure they'll cover the surgery. A lot of insurance companies don't
look at the benefits of WLS - they just look at today's bottom line and
play the odds that you might change insurance companies in the future, etc.
Also, if you take a loan with CareCredit be careful dealing with them. I
had a few bad experiences with them and used another credit agency to pay
off the loan with them. Good luck - I'm sure your insurance company will
come through after you beg them. Everyone should see the movie
"Sicko".
— Muggs
February 19, 2009
Hate to be the bearer of bad news but it is difficult to get ANY insurance
provider in FL to pay for WLS. BCBS included! First find out why you were
denied. Then appeal (which I suggest you do) but do so with the assistance
of legal professionals www.obesitylaw.com is a GREAT place to start. Good
luck!!!
— maggiesmiles
February 19, 2009
There is a place that offers financial help for those that can't get help
from their insurance company. www.carecredit.com You can apply for that
and see if they'll help you. Good Luck.
— Stacie2
February 20, 2009
Thanks for all the advice but bcbs says I do not have the benefits on my
plan so I guess the only way to wls surgry is to finance it myself I will
apply to that finance co. and again thanks for the help!
— googley4me2000
February 20, 2009
Most insurance companies say "Excludes Weight Loss" forms of
weight loss, blah blah blah, unless necessary. I had BCBC of Calif. and
their policy said that too, but if a doctor deems it medically necessary
you should get it. They might deny it first but keep putting in appeals.
I got denied the first time but due to lack of information. I really didn't
pay much attention to the excludes weight loss, but most insurance
companies will only cover the RNY. It only took me about 6 months from
start to finish, so don't give up. You might have to jump through hoops,
but it is worth it. Best Wishes to you.
— Kristy
February 20, 2009
My insurance also denied me - even after 3 appeals! They acknowledged I
needed it, but my insurance policy specifically prohibits coverage for
weight loss surgery. Someone somewhere online had said they were able to
get it paid for by Department of Vocational Rehabiliation. Every state has
this agency, but it may be a different name in your state. It took me
nearly two years because my first case manager didn't follow through with
anything - once I got my new case manager, it was approved in 6 weeks - and
4 weeks later I had the surgery. They covered it because I wouldn't be
able to continue to work at my job if I didn't get the weight off - my job
requires me to do a lot of walking and physical activities. It doesn't
hurt to check it out.
— Wendy M.
February 21, 2009
i have bcbs of georgia. my insurance wouldn't cover my surgery either.
they said it was cosmetic. i have diabetes and use an insulin pump. i
found out that my group insurance thru my job totally excluded this type of
surgery on our policy. it's like companies can pick and choose what they
are willing to cover according to the premium prices they want to pay.
so for me i chose to have my surgery done in mexico. i paid 7500.00
versus 25000.00 her in the US. i have saved my insurance company many
dollars. i am now on diabetes pills instead of insulin. i am 14 weeks
post op and down 60 lbs. gook luck!!
— gingersue
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