Question:
I don't know what to do, where to turn, how to get help, but I am desperate!
I am a resident and state employee of Texas. I am currently insured by BCBS Health Select of Texas. I called the insurance and they do not cover any type of bariatric procedure, as stated in the policy exclusions. What now? Do I write an appeal letter? If so, how do I go about doing this? Do I go through my PCP? Should I look for other financing options? Is there another insurance company I could get a temporary policy from? I am so full of despair; I don't know where to turn. I am 29 years old, and I am desperately wanting to have a child, but with my condition (PCOS), it is next to impossible with all the extra weight. I've been on every diet imaginable, and I just want to get some help. I'm on depression medication to boot. If anyone has any shred of information about this in Texas, I would be forever greatful. — lotero (posted on October 19, 2005)
October 19, 2005
Lara,
Since it is open enrollment season for benefits, check out the insurance
companies that the state offers and then choose one of those. You may want
to also consider changing to a PPO to see if that will increase your
chances. My partner had the surgery and she used the PPO version of her
insurance. She is a federal employee and used an agency call Mail Handlers
-- I don't know if they will insure state employees. Mail Handlers is the
insurance company used by the Postal Service. Check out all your options
-- don't give up. BCBS want even cover the procedure for health reasons?
That's unusual. I guess the insurance companies are opting for people to
workout and change their eating habits rather than to pay for the surgery.
Get your Primary Care, your OB/GYN involved in the process. They must have
documented the dangers you would incur if you were to become pregnant at
this time. DON'T GIVE UP!!!
— the7thdean
October 19, 2005
I understand how you feel. I also have BSBC but the TRS version since I am
a teacher. I had to wait about 6 months and to my doctor each month to have
my weight checked. I finally wrote an appeal letter and they ok'ed my
surgery within two weeks. My surgery was last summer; June 28th. They
totally paid everything except my doctor which did pay about 3000 to. I
still owe him around 2000 which I am getting paid off slowly but surely.
lol Have both your regular and WLS doctor's write a letter to the insurance
agency explaining your situation since it is regard to your health. It
couldn't hurt. Bless of luck to you. I understand exactly how you feel;
never give up. I will be praying for you.
Laural
HW-313
SW-292
CW-235
Goal-135
— Laural D.
October 19, 2005
I truly relate to your issue, it seems I was in the sme boat as you a few
years ago, I am also obese with a BMI of 59, I too have the PCOS and cannot
have children, also had the BCBS of MO with the same exclusion. I wrote
tons of letters my PCP wrote letters, every one I could get I had them
write, even my employer threatened the insurance company that she was going
to sue for dicrimination and drop them as a carrier for the company BCBS
does not give! I have been unable to have children because of the PCOS
because of my weight and was told that weight loss cures PCOS and many
women are then able to bear children. I too was depressed, even thoughts of
suicide. Been married for 15 years and it was going down hill.
I changed my life changed, I left my husband, met a younger man, fell in
love, he with me. We found out the military insurance DOES pay for the
operation with no exclusions, he joined so I could have my surgery, May
surgery date is now 17 days away.
Email me, I will be glad to talk to you and tell you everything I done and
tried, I will try to help you not have to go through the hell I went
through, getting hopes up and then getting them shot to hell, etc
[email protected]
— Leah P.
October 19, 2005
I have Blue Cross PPO and my hubby is a state employee in
California.......the EOC book stated that bariatric surgery for weight loss
was not covered. Well it was a lie .....I was considered morbidly obese so
the exclusion did not apply!!!! I would call a few surgeons offices in
your area or ask some other employees in your building if any of them have
had WLS paid for under your policy? I would defintely pursue this and not
assume that it is excluded no matter what the book says. I also wouldn't
pursue WLS under the pretense that you have fertilty issues......or this
could hamper your efforts even more. Focus on curing your other
comorbitities and you may get farther with the insurance company. Wendi
— lovemonterey
October 20, 2005
Lara,
My policy states that bariatric surgery is not covered, and then later
specifies that if it is medically necessary they will pay and they ok'd my
surgery. Go to the obesityhelp.com's insurance page and it will tell what
insurances have paid. then contact someone who had the same as yours, or do
like I did, change insurances, but first check them all out by asking on
the board, who has this insurance to email you.
— geneswife
October 21, 2005
www.obesitylaw.com
Walter Lindstrum is an attorney who has devoted his life to helping wls
patients get the services they deserve from their insurance companies. He
will be able to tell you if you have a Chinamen's chance in H**L with a
written exclusion policy.
There is also an opportunity to change insurance policies for awhile in
order to have your surgery. The other option is to self-pay.
Hugs,
Flo
— Flo
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