Re: Post-Ops from Blue cross where are you

[Guest guest]

I live in California but I have the Federal Employee Program flavor

of Blue Cross. They have been great so far... No problems.

You would think that Blue Cross would be Blue Cross. Sadly that is

not the case. There are quite a few different flavors of BC...

Hull has good info that could be used for appeals, if you have

to go there.

That's not much help.

Greg

[Guest guest]

Hi Steve:

> I am hoping to talk to as many post ops who had

> Blue Cross insurance and how they got approved,

> I'm talking CALIFORNIANS........as that is the group B/C is denying.

I have an individual BC PPO under the State of California's Major

Risk Medical Insurance Program, (MRMIP for short).

I was switched on March 30, 2001, and I had no problems getting

approved whatsoever. I didn't have to document any previous weight

loss attempts, have a referral from a PCP, or any of that stuff. But

that may not be so significant -- I think BC started changing their

policies after I was switched.

Here's one possible ray of hope for you though. My surgeon, (Dr.

Anthone at USC), likes to perform a panniculectomy (massive tummy

tuck) PRIOR to the DS on patients who have a large hanging belly --

it helps us be more mobile after the DS, thus preventing deep vein

thrombosis, pulmonary embolism, etc...

Anyhow, in theory, Blue Cross will not pay for a panniculectomy under

almost any circumstances, because it is " cosmetic " -- let alone

paying for a cosmetic surgery on a five-foot five-inch, 386 pound

patient! Dr. Anthone got it approved fairly easily though, by

calling the insurance company himself and talking directly to the

doctor in charge of the Denials Department, (or whatever they call

it).

I think the best way to get an approval for your DS would be to

follow this same strategy, i.e., get your surgeon to talk directly to

the doctor at Blue Cross and explain -- one MD to another -- why YOU

need THIS surgery.

Good luck!

Tom

USC DS Support Group: <http://groups.yahoo.com/group/ds_usc>

Panniculectomy, Dr. Anthone, 11/10/2000

Open DS, Dr. Anthone, 03/30/2001

11/10/2000 . . . . . . 386 (Panniculectomy)

03/30/2001 . . . . . . 360 (DS)

04/19/2001 . . . . . . 338

05/03/2001 . . . . . . 328

05/18/2001 . . . . . . 316

06/03/2001 . . . . . . 301

06/15/2001 . . . . . . 299

06/25/2001 . . . . . . 293

07/03/2001 . . . . . . 286

07/16/2001 . . . . . . 278

07/23/2001 . . . . . . 276

07/30/2001 . . . . . . 275

08/06/2001 . . . . . . 272

Goal Weight . . . . . 185

Lost So Far . . . . . 114 Ugly Pounds

Remainder to Goal 87

[Guest guest]

Steve,

I know you wrote and said that you have BC of CA but EXACTLY what

plan is it? The reason I ask is if you can find (in this Database

and/or on Obesityhelp.com) anyone that they have covered the DS for

it will help you a lot. If they have covered it in the past then they

have set a historical precedence that they do pay for the DS. For

them to then not cover yours would be discrimination and uneven

distribution of company policy. If you can state in your appeal the

names and dates of service for the other members that they covered

then I would think they couldn't turn you down.

This is what I had to do for my 1/23/01 surgery with BCBS Fed and

they have since paid my claim.

Best of luck,

-- In duodenalswitch@y..., sfgclimbhi@y... wrote:

> I am hoping to talk to as many post ops who had Blue Cross

insurance

> and how they got approved, your struggle if any, and suggestions

you

> may have that will get Blue Cross to budge.

>

> C'mon......nows the time to help out, speak out--discreetly if need

> be.

>

> Even the approved pre-ops it would be good to hear from you

folks.....

>

> I'm talking CALIFORNIANS........as that is the group B/C is denying.

>

> Steve G.

[Guest guest]

> " . . .get your surgeon to talk directly to

> the doctor at Blue Cross and explain -- one MD to another -- why

>YOU need THIS surgery. "

Tom -

According to Dr. Keshishian's office, he is in direct contact with BC

on an almost daily basis, apparently without any positive result so

far.

Nick in Sage

[Guest guest]

> " . . .get your surgeon to talk directly to

> the doctor at Blue Cross and explain -- one MD to another -- why

>YOU need THIS surgery. "

Tom -

According to Dr. Keshishian's office, he is in direct contact with BC

on an almost daily basis, apparently without any positive result so

far.

Nick in Sage