Guest guest Posted April 30, 2001 Report Share Posted April 30, 2001 Hi Gobo, I have BCBS Fed as my primary insurance and they denied my Lap DS (W/ Dr ) as experimental and investigational. Do you remember who you spoke to that said that the DS was a covered surgery? Did you give them the CPT codes 43847 and 43633 or did you give the name of our surgery? Did you call the WA or OR office? Dr 's office sent the corrected rebill 2 weeks ago so I am (NOT) patiently waiting! Thanks in advance for the info. - In duodenalswitch@y..., " gobo " wrote: > > > I thought if I got approval through > > PacifiCare then I would try to COBRA off the policy to finish out > through my > > surgery. I just hope this is possible. > > > > > > Janice; > I hate to be the bearer of bad news but I am under the > impression that the COBRA plan does not work that way. It's to > provide continuous coverage if the employee is separated from > the company not the other way around! > > However, I looked up Blue Cross/Blue Shield. Here's the URL for > Texas: > > http://www.bcbstx.com/ > > Incidentally, I ALSO have Blue Cross as my secondary insurance > (after Medicare). I can't say that they operate by the same rules > because my Blue Cross is through the Federal Government and > I have the High Option. > > However, under 'Exclusions and Limitations', my policy says big > as day, " Excluded - All treatment for weight loss purposes with > the exception of gastric bypass surgery " . There is no > discrimination between R-n-y and DS; the term 'gastric bypass' > is meant generically. I'm confident on that because I've double > checked with Blue Cross. > > If your husband's insurance DOES switch, I would recommend > getting the 'High Option' for the duration of getting the surgery. > Once you're done, you can switch back to the standard option. > The reason I recommend this (it IS much more expensive) is > because the restrictions are far less. A person is entitled to more > things with the high option than they are with standard and you > only pay half as much in deductibles and co-pays. So, for the > duration of having WLS, this would be worth the higher premium. > Then, afterwards, the next time his company has an > open-enrollment period, you can move down to standard plan if > it's an option. > > You could even try calling Blue Cross of Texas and asking them > what their policy is on " GASTRIC BYPASS SURGERY " (I would > word it that way). Be sure and reassure them that you are > inquiring about a case where it is medically necessary. They'll > want to know the member number and you can jut tell them that > there isn't one YET but it would be a GROUP policy and their > answer will help determine whether the individual will be signing > up with them. If they tell you they need to know, tell them that you > simply are inquiring as to whether they ALWAYS, SOMETIMES, or > NEVER cover it. > > If they say never, remind them that the FEDERAL plan ALWAYS > does and the Federal Government's plan is rather conservative. > > Please do this. You might be pleasantly surprised. Oh yes, ask > them if you have surgery in Portland, would your policy be billed > to the Oregon Blue Cross and if so, would it go by the same > coverage details as Blue Cross of Oregon? That's exactly what > mine does; it's administered by Blue Cross of Washington but > bills go to the local Blue Cross wherever I have Medical > treatment. > > Good luck Janice! > > hugs, > gobo > DS pre-op > BMI 56 > > " Sometimes We Never Know How We Influence the Lives of > Others, Yet We Touch Those Lives Just the Same " Quote Link to comment Share on other sites More sharing options...
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