Guest guest Posted November 4, 2001 Report Share Posted November 4, 2001 Go to the DS-Insurance Authorization site. There is a lot of good info. and plenty of people fighting BCBS issues. > I have bc/bs of Alabama and am trying to get approved for the DS . I have been denied ,they say it is considered investigation. Has anyone with this insurance been approved for the Ds. > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 4, 2001 Report Share Posted November 4, 2001 I had bc/bs of South Dakota and they approved it in less than 48 hours, but I have NO idea if there is any link between SD and Alabama. Good luck! > I have bc/bs of Alabama and am trying to get approved for the DS . I have been denied ,they say it is considered investigation. Has anyone with this insurance been approved for the Ds. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 5, 2001 Report Share Posted November 5, 2001 Sounds like an iron clad exclusion to me. My daughter had one such as this on the Washington State employees insurance (all of their providers) that has not been broken AFAIK. She went to Spain and had Dr Baltasar do it. Only way to change this is to have the employer change their options with the insurance company when they renew their contract. The less hte insurance covers, the less the employer pays. It isn't the insurance company doing this to you, it is the employer that chooses to buy insurance for employees and have this exclusion in it. /Seattle > I went to the website for my insurance company, and this is what they > had to say: It exculdes... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 5, 2001 Report Share Posted November 5, 2001 Toni, That's a pretty ironclad exclusion, unfortunately!! When is open enrollment at your company and what are the other choices ? Do you have a PPO option ? I would ask HR for the benefit books of the other programs. You can just let them know you're thinking about switching plans and you want to compare the level of coverage. Good luck! *hugs* Anita Surgery Date 11/08/01 Dr Keshishian P.S Toni, I switched from Kaiser HMO to Great West PPO..my GW policy did not have any exclusions and I had to wait a year to switch during open enrollment this year, but after my LOMN was sent out, I was approved less than 24 hours!! > I went to the website for my insurance company, and this is what they > had to say: It exculdes... > > " any surgical procedure intended primarily for treatment of morbid > obesity, including gastric bypass and jejunal bypass or complications > of bypass surgery. Also, weight loss programs or clinics that utilize > very low calorie supplement in any form, such as liquid or pre- > packaged food and all related laboratory or diagnostic testing, > vitamins or medications. " > > What should I do? I haven't even gotten to talk to a surgeon yet, > and I'm already hitting brick walls!! > > > BTW... to those I talked to in chat on Sunday... thanks for answering > all my questions! You are a great group! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 5, 2001 Report Share Posted November 5, 2001 Thanks for the responses... unfortunately, this isn't my company. I am still under my mom's insurance and it would be up to her to have to go bug HR. I'm pretty sure she wouldn't want to do that and make waves with the company, if you know what i mean.... Guess I'll go on living the life of a fat girl.... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 5, 2001 Report Share Posted November 5, 2001 Wow. Brutal. And what, pray tell, is the name of this compassionate and forward thinking insurance company so I can warn my children and their children's children away from them! :[ Jean. insurance denial > I went to the website for my insurance company, and this is what they > had to say: It exculdes... > > " any surgical procedure intended primarily for treatment of morbid > obesity, including gastric bypass and jejunal bypass or complications > of bypass surgery. Also, weight loss programs or clinics that utilize > very low calorie supplement in any form, such as liquid or pre- > packaged food and all related laboratory or diagnostic testing, > vitamins or medications. " > > What should I do? I haven't even gotten to talk to a surgeon yet, > and I'm already hitting brick walls!! > > > BTW... to those I talked to in chat on Sunday... thanks for answering > all my questions! You are a great group! > > > > ---------------------------------------------------------- ------------ > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 5, 2001 Report Share Posted November 5, 2001 Wow...that's a pretty iron-clad exclusion unless you have serious comorbs -- if you had serious comorbs, then the wls could be in treatment for those, not necessarily for the obesity,b ut it's a hard row to hoe. Since this isn't your ins coverage on your own, what about getting a job where you get your own coverage? I'd be looking out for a company w/o an exclusion...exclusions can be difficult to get around. :/ ~alyssa insurance denial > I went to the website for my insurance company, and this is what they > had to say: It exculdes... > > " any surgical procedure intended primarily for treatment of morbid > obesity, including gastric bypass and jejunal bypass or complications > of bypass surgery. Also, weight loss programs or clinics that utilize > very low calorie supplement in any form, such as liquid or pre- > packaged food and all related laboratory or diagnostic testing, > vitamins or medications. " Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 6, 2001 Report Share Posted November 6, 2001 This is Humana HMO... grrrrr!!! I just get so angry! I'd get a job for insurance of my own, but i'm already working 3 part- time to pay for school... if i had to worry about insurance premiums on top of that, I think i'd go crazy! I hate to do it, but i may have to wait another 2 or so years till I graduate and get a real job and insurance of my own.... But i really don't want to wait that long... who knows what i could look like in 3 years at this rate... > Wow. Brutal. And what, pray tell, is the name of this > compassionate and forward thinking insurance company so I > can warn my children and their children's children away from > them! :[ > > Jean. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 6, 2001 Report Share Posted November 6, 2001 Does your mom have an option of Humana PPO? That's what I have and I was approved about three weeks ago without any problems. Or does she have some other PPO she can pick from. They seem to be a lot better about paying. I'm not sure where you saw that exclusion on their website but also check your individual policy. The policies vary alot it's possible what you saw on the web weren't specific to your policy. I know information for our policy (Employer's Health) isn't available on the web. > > This is Humana HMO... grrrrr!!! I just get so angry! > I'd get a job for insurance of my own, but i'm already working 3 part- Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 6, 2001 Report Share Posted November 6, 2001 This is from my individual policy. I had to log into their network to get access to it. What is a PPO? I've never had that. We were part of Family Health Plan until that went belly up and her company switched to Humana. It really sucks! I had to give up the PCP that I'd had since I was 9. > Does your mom have an option of Humana PPO? That's what I have and I > was approved about three weeks ago without any problems. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 6, 2001 Report Share Posted November 6, 2001 > This is from my individual policy. I had to log into their network > to get access to it. What is a PPO? I've never had that. We were > part of Family Health Plan until that went belly up and her company > switched to Humana. It really sucks! I had to give up the PCP that > I'd had since I was 9. > I forgot exactly what the letters stand for but basically they allow you to see doctors that are not part of the group but you will pay more if you do. WIth an HMO you have to get a referal to see a specialist or go out of network with a PPO you can see whoever you want. I hate changing doctors too. My husband changes jobs about once a year so I'm forever trying to find new doctors. I found one I really really liked and had her for about nine months and I haven't been able to go back since the last 5 insurances we have had didn't cover her. My husband is good and finding insurances I don't like. While I'm not thrilled with my choices of in network doctors with Humana. I will say they have been very good about paying the bills. Much better than some of them that we have had. Talk to your mom and see if she has some options. Good luck with your search. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 6, 2001 Report Share Posted November 6, 2001 In a message dated 11/6/01 3:54:25 PM Eastern Standard Time, ctybnd@... writes: << A PPO is Preferred Provider Org. Basically it mean if you go to a provider the insurance company prefers, they will pay more of your bill. That's what we have and have had no problems at all. >> Hi, I think some PPO's must be different than others. with my PPO if I go to a Preffered Provider (in network so to speak) the dr or hospital is required to accept whatever the insurance pays, and not ask the patient for more. One reason I like it is because it's not an HMO. I don't need approval from a PCP to see a specialist. Sheryl Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 6, 2001 Report Share Posted November 6, 2001 A PPO is Preferred Provider Org. Basically it mean if you go to a provider the insurance company prefers, they will pay more of your bill. That's what we have and have had no problems at all. > > This is from my individual policy. I had to log into their network > > to get access to it. What is a PPO? I've never had that. We were > > part of Family Health Plan until that went belly up and her company > > switched to Humana. It really sucks! I had to give up the PCP that > > I'd had since I was 9. > > > > I forgot exactly what the letters stand for but basically they allow > you to see doctors that are not part of the group but you will pay > more if you do. WIth an HMO you have to get a referal to see a > specialist or go out of network with a PPO you can see whoever you > want. I hate changing doctors too. My husband changes jobs about > once a year so I'm forever trying to find new doctors. I found one I > really really liked and had her for about nine months and I haven't > been able to go back since the last 5 insurances we have had didn't > cover her. My husband is good and finding insurances I don't like. > While I'm not thrilled with my choices of in network doctors with > Humana. I will say they have been very good about paying the bills. > Much better than some of them that we have had. > > Talk to your mom and see if she has some options. Good luck with your > search. > Quote Link to comment Share on other sites More sharing options...
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