Guest guest Posted August 26, 2000 Report Share Posted August 26, 2000 I work at bcbs of TN, i know that our " core " HMO policies do cover surgical treatment of obesity, just give them a call and see what they have to say, call 2 or 3 different times though, because sometimes people just dont really know what they are talking about, and will tell you anything to get off the phone. I cant say for certain about your policy as each BCBS is different, but good luck!!!!! Tina Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 26, 2000 Report Share Posted August 26, 2000 In a message dated 8/26/2000 8:18:03 AM Eastern Daylight Time, CLBR1@... writes: << I work at bcbs of TN, i know that our " core " HMO policies do cover surgical treatment of obesity, just give them a call and see what they have to say, call 2 or 3 different times though, because sometimes people just dont really know what they are talking about, and will tell you anything to get off the phone. I cant say for certain about your policy as each BCBS is different, but good luck!!!!! >> I read the policy's " exclusions " and surgical treatment for obesity is listed as an 'exclusion, with the exception where deemed medically necessary.' BUT, would they approve the MGB? or make me go to someone 'in network'? There's no way I'm getting an RNY.... Yeah, it's only like an extra $100 a month for the PPO, so I think we'll just switch to that... ::Sigh:: Robin Wife to Doug Mommy to Tyler, 4 yrs., and Brennan, 1 yr. Singer, wife, mom, secretary.. and not in that particular order. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 26, 2000 Report Share Posted August 26, 2000 In a message dated 8/26/00 5:12:02 AM Pacific Daylight Time, MomInSWFL@... writes: << What I'm looking for advice from you all is: Should I try first to get the HMO to approve the MGB, and if they deny me, then upgrade to the PPO and go >> Hi Robin, I'm no expert, but Chris' and my surgeries were covered as " in network " by an out of state HMO. Before changing, I would check the policy and see if it has an exclusion for WLS. If it does, though some people have gotten this overturned, I would consider switching. Otherwise, with no exclusions, I would say you should stick with the HMO. What does everyone else think? Regards, Debbie in IL MGB 8/10 Cigna approved as " in network " Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 26, 2000 Report Share Posted August 26, 2000 In a message dated 8/26/00 7:31:20 AM Central Daylight Time, MomInSWFL@... writes: << I read the policy's " exclusions " and surgical treatment for obesity is listed as an 'exclusion, with the exception where deemed medically necessary.' BUT, would they approve the MGB? or make me go to someone 'in network'? There's no way I'm getting an RNY.... Yeah, it's only like an extra $100 a month for the PPO, so I think we'll just switch to that... ::Sigh:: Robin >> Dr. Rutledge is in the BCBS network. I'm not sure if you have the clause that says you can use doctors that are in network when you are out of your area at network rates, but my insurance lady told me that I can. I think it is the " Blue Cares " program. Check to see if you have that. My insurance still hasn't paid yet, I will post how much they pay and at what rate when I get my EOB. Deb in IL Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 26, 2000 Report Share Posted August 26, 2000 In a message dated 8/26/2000 9:22:57 AM Eastern Daylight Time, DebLaMan@... writes: << I'm no expert, but Chris' and my surgeries were covered as " in network " by an out of state HMO. >> Thanx for your input, Debbie! This whole insurance thing is the only thing I'm not looking forward to.... one of those 'necessary evils'. ) Robin Wife to Doug Mommy to Tyler, 4 yrs., and Brennan, 1 yr. Singer, wife, mom, secretary.. and not in that particular order. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 26, 2000 Report Share Posted August 26, 2000 they should approve the mgb, espically if you explain to them that its cost is much much less than any type of obesity surgery. tina Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 26, 2000 Report Share Posted August 26, 2000 In a message dated 8/26/2000 9:59:51 AM Eastern Daylight Time, Hadjab@... writes: << Dr. Rutledge is in the BCBS network. I'm not sure if you have the clause that says you can use doctors that are in network when you are out of your area at network rates, but my insurance lady told me that I can. I think it is the " Blue Cares " program. Check to see if you have that. My insurance still hasn't paid yet, I will post how much they pay and at what rate when I get my EOB. Deb in IL >> I am thanking my lucky stars and the Lord above for having found such a supportive and knowledgeable group. Thank you again, Debbie, and all! I'll check my handbook later and will let you know what it says! That would be cool to not have to switch! Robin Wife to Doug Mommy to Tyler, 4 yrs., and Brennan, 1 yr. Singer, wife, mom, secretary.. and not in that particular order. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 26, 2000 Report Share Posted August 26, 2000 In a message dated 8/26/2000 12:06:40 PM Eastern Daylight Time, ereceptionist@... writes: << My advice is you call and request coverage books for both types of coverage! >> Excellent suggestion, Sara! Maybe my hubby can even get one from Human Resources, at work! I'll have him check on Monday... Thanx again! ) Robin Wife to Doug Mommy to Tyler, 4 yrs., and Brennan, 1 yr. Singer, wife, mom, secretary.. and not in that particular order. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 26, 2000 Report Share Posted August 26, 2000 Robin, My advice is you call and request coverage books for both types of coverage! I have been on my company's HMO and was considering the change for the surgery reason as well, but when I read the exclusions, the PPO had a very definate exclusion and the HMO said not covered unless medically necessary! Now I have not begun that fight yet, and I know it won't be easy, but at least there is a point to argue! I hope this helps! Houston, Texas BMI 50 HMO or PPO? Hi everyone.... I realized yesterday that our insurance through my hubby's work is either BC/BS HMO or PPO... we currently have the HMO, but can upgrade to the PPO at any time. What I'm looking for advice from you all is: Should I try first to get the HMO to approve the MGB, and if they deny me, then upgrade to the PPO and go for it? As far as pre-existing goes, from what I understand, as long as we don't go without coverage for any period of time, it doesn't apply... I mean, if we drop the insurance and a couple weeks later sign up for the PPO, then the pre-existing stuff would affect us, but as long as we just upgrade, it doesn't. But I'm not so sure they'd even LET us upgrade after the HMO declines the surgery as out of network, ya know? I'm leaning towards just upgrading to the PPO and going through it that way, then we can switch back to the HMO after the surgery. or maybe not? ugh.... WHAT A MESS! Any advice would be appreciated!! Thanx, as always! Robin Wife to Doug Mommy to Tyler, 4 yrs., and Brennan, 1 yr. Singer, wife, mom, secretary.. and not in that particular order. This message is from the Mini-Gastric Bypass Mailing List at Onelist.com Please visit our web site at http://clos.net Get the Patient Manual at http://clos.net/get_patient_manual.htm To Unsubscribe Send and Email to: MiniGastricBypass-unsubscribe (AT) egroups (DOT) com Quote Link to comment Share on other sites More sharing options...
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