BC/BS

[Guest guest]

Avid lurker here. I'm posting a summary because maybe some of the

information will help you guys, who knows. The issue of BC/BS mostly

depends on the letter the doctor writes. That is, if your employer bought a

policy from them that even covers WLS. I used to have CIGNA and the policy

that our company had, listed exclusion for anything to do with obesity

(morbid or otherwise). They even balked at paying for bloodwork

investigating hormone levels that had been mistakenly coded for obesity.

Anyway, different employer, different ins. Jan 1, 2001, BC/BS of TN. No

information from employer indicating exclusion. Consult with Dr Anthone in

late July. BC/BS asked for additional info (how long have you been really

fat? response: over 20 years) they said good enough and stamped me

approved. Had all pre-op testing done late October. Psych test done late

November, and surgery date scheduled for early January. n called to

advise BC/BS of surgery date and approval had been withdrawn. Needless to

say this precipitated a flurry of calls on my part. Bottom line. BC/BS had

no problem with approving the procedure. Investigational, yada yada never

mentioned. The problem is that their approval process had a glitch that

failed to recognize my employers previously unknown exlusion. They fixed

this glitch in early November. (One reason I never buy lottery tickets).

My employer refuses to waive the exlusion, which of course includes any form

of treatment for any form of obesity (and yes, tried the " treating the

co-morbidities and weight loss is just a side effect " and " will save you

money in the long run, balancing it with the treatments I will have to have

if not approved " to no avail.).

Be aware, while I was talking to one of the many people at BC/BS of TN, they

advised that one of their employees recently died, evidently from

complications of WLS. I didn't ask which procedure. But they said that

factor was prompting them to, as a company, in the very near future,

disallow ALL WLS. This will mean that the option will not even be offered

to purchasing employers. Does this mean all BC/BS? Dunno. What I do know

is that I see a lot of people on most of the support groups I subscribe to,

trying to ascertain which insurance companies cover WLS and which ones

don't. Its not just the insurance company.

Does your insurance company offer it as an option to the purchasing

employer?

If offered, did your employer purchase that option?

If that option was purchased, will it cover the particular procedure you

want?

Can your surgeon write a letter that is worded in such a manner as to garner

approval?

If you qualify. If all the planets align and you receive approval. Run

don't walk. Do not worry about fitting your surgery around your schedule.

If you want it bad enough, fit your schedule around your surgery. Don't

look a gift horse in the mouth.

Strike while the iron is hot....on and on and on. Because of my work

schedule, everything was done as quickly as it could have been, but for the

lack of 4 lousy weeks....ah well, hindsight is always 20/20. I will be

picking up the gauntlet again the first of the year. Thanks for your

time.....Lori