Question:
has anyone been approved with there BC/BS policy read like this?
I have BC/BS plan code 340/840 with a written exclusion that reads "treatment of obesity, regardless of the patient's history or diagnosis, including but not limited to the following: weight reduction or dietary control programs, prescription or non prescription drugs or meds such as vitamins, minerals, appetite suppressants, or nutrional supplements, and any complications resulting from weight loss treatments or procedures." Has anyone had their policy read like this and been approved? -Monette — Monette L. (posted on May 7, 2002)
May 7, 2002
yes mine read the same way but look at the wording it says obesity were
morbid obese and there is a difference ask them about morbid obesity i will
be having my surgery on may 14th and i have bc/bs care first ppo and they
did not stall at all it`s in my profile good luck
— rochele1970
May 7, 2002
My policy reads the same exact wording and my surgery is scheduled for May
15th..woo hoo! I have BC/BS of FL Health Options (HMO) and I was originally
denied for not having 12 months of medically supervised weight loss
history. After sending in an appeal with my medical records for the last 3
years, I was approved. The criteria that BC/BS explained to me in order to
qualify were: 1. Being morbidly obese with a BMI greater than 40 2. Minimum
of 12 months of documented medically supervised weight loss attempts 3.
Psychiatric evaluation Hope this helps. Good luck on your journey!
— Rachelle P
May 7, 2002
That part is just talking about diets and things like that. Look under
Surigical Procedures. It would be listed there.
— Lisa N M.
May 7, 2002
I have BC/BS HMO in New Mexico. My exclusion read like yours except it
said "morbid obesity". No loop holes. If it doesn't say
"morbid obesity", I think you have a shot.
Best of Luck. By the way, I private paid, best 12,000 I ever spent. I am
almost 8 months post-op and down 90 lbs.
Margie
— Margie W.
July 10, 2002
I have BC/BS Blue Choice and just learned that "weight loss" is
not covered by my policy. However, they approved my lap roux-n-y a month
ago and I had my surgery June 6, 2002. This all came about because they
were not paying for post-surgical follow-up saying it was weight loss. Go
figure. They finally told me that I needed my primary care doc to make the
referral for the post surgical treatment to be covered.
— Thomas M.
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