insurance problems

I have been to a seminar at Southwest Medical In Dallas. They told us to contact our insurance to see if our particular policy covers what their medical policy says they do. i have BCBS of Illinois. They have a medical policy for gastric bypass. i have to see my PCP monthly, for 6 mo. and provide documentation of obesity for last 5 yrs. Also, have psych eval and see dietitian. I have been doing this for the last 2 months. i finally got around to calling BCBS today. They told me that, yes, my policy covers WLS, but they exempt certain codes and obesity and morbid obesity are exempted. Has anyone had this happen. I am so afraid that this will mean no coverage. I have read that denial can be overturned but not an exemption.

Hi Lana, I'm not familiar with BCBS, I have Medicare so unfortunately I can't help.. I just wanted to say hang in there.. it's been a very long process for me to get a surgery date. Don't give up and get down on yourself.. Keep on keeping on girl! I'll keep you in my prayers and best wishes for you!

Hey Lana, So did they say you would be exempt or just obesity/morbid obesity? I'm taking it they only approve the Super Obese? I really hope you get it worked out. I have Tricare and I was approved via my military Dr. . .that's all really my insurance needs is my Dr to say its medically necessary and they'll approve it. I wanted to wish you all the luck in the world though and let u know to hang in there. Hopefully they'll come around and you'll get an approval. Lots of love and you'll be in my thoughts and prayers!!

Kelly, I have Tricare too! It was a breeze to get approval. Sounds funny huh? I have never thought of Tricare as easy. You do know that Tricare just picked up the Lap-Band. I wonder if I was one of the firsts to take advantage. Ok, now to be nosy. What branch of the military are you married too? Lana, Insurance is the biggest obstacle. My word of advice is to figure out the exact requirements and do what is necessary to meet those requirements. That way, if you are denied, it should be an easy appeal process. Also, expect to be denied the first time. It is just the way insurance companies work. Good luck!!

Yes, I have issues with my insurance also. I was denied the first time. The insurance company stated that they would pay for the procedure but it has to be medically necessary. So I am praying that I get approve. I will also keep you in my prayers as well

hi Lana, You should post this on the Insurance Help Forum. Also on the main page of that forum, you can search insurance companies by state. I went to Illinois and found BC/BS IL. There are several listings of people who had similar problems. Some of them succeeded. Read these and contact the successful members. There is also a WLS grad who is a lawyer who hangs out on that forum. He may be able to point you in the right direction. Good luck, Jayne