Question:
How do I get a straight answer from my insurance company?
I went to the seminar for the lap band procedure and they told us to call our insurance company and make sure they cover the surgery, Well I havent gotten a straight answer from them yet. I have called them SIX times and one peson tells me Yes they cover it and another tells me NO they dont cover it. This has been going on for a week now If anyone can help me Id really appriciate it. I have Blue Cross Blue Shield and they dont seem like they want to help, its like I am a bother to them. — Dee52 (posted on March 23, 2006)
March 22, 2006
Denise, When I called to find out if the surgery was covered the insurance
asked for the coding number. As I was talking to the lady at the insurance
company she asked for it and I told her I didn't have a number. She called
the Doctors office and got the number for me. Well she called back and told
me it was covered and she even gave me the number. You might try calling
with a coding number.
Good luck!
— Sheila_E
March 23, 2006
Denise, ask BCBS for their written manual on what they cover for bariatric
surgery. I used BCBS of IL and they directed me over the phone to their
website version of their manual (that they update yearly) and there I can
read line for line what types of procedures they do and don't cover and
what stipulations there are... Just call and ask them to direct you online
to where you would go to see such information. And demand it... don't take
no for an answer! Good luck!
— SJSlesnick
March 23, 2006
You need to read the most current copy of your policy and see if WLS is
covered or not. A coding # has nothing to do with if it is a covered
procedure or not, all procedures have coding #'s, even non covered
procedures. All cases are coded in the hospital including free care and
self pay. 1 reason records are coded are for statistical purposes. Just
becuase you have a code# it doesn't equal payment from the insurance
company.Unless you can afford to be self pay, its worth the effort to
obtain this information before you proceed further in your journey. Also
you could call your benefits person in HR and check with them about if WLs
is covered.
Good Luck
good Luck
— goldroses
March 23, 2006
When I decided to do the procedure, all I did was make an appointment with
the surgeon I was considering. After I decided to go ahead with it, they
did it all for me. I never once called my Insurance company. I was approved
right away. I have Oxford Freedom Plan. Good Luck!
— MikeL
March 23, 2006
Insurance companies (eyes rolling)! Of course it seems that they don't
want to help you. As long as you are healthy and they are taking your
cash, you are their friend, if you want to spend their money -- that's a
whole different story. My insurance company did the same thing to me...
covered, not covered, different day, different answer! Eventually, they
became consistent with the denial and only changed their rational --
medically necessary but excluded; not medically necessary (even though my
surgeon deemed it medically necessary).... You have to get your surgeon to
submit the request in writing, and then the insurance needs to respond in
writing -- once it's in writing, you have your answer... As for me, I'm
heading to Brazil in 10 days for a self-pay duodenal switch and a couple
weeks in beautiful Curitiba! :)
— [Deactivated Member]
March 24, 2006
Denise, I have BC/BS PPO. I had just about the same thing happen to me,
different day, different story. The suggestion about the code #...they are
right. BC/BS will ask for a code #. That is what they use to tell you if
the procedure is covered or not. Either your surgeon or your PCP should be
able to give you that number. If you have any question, don't hesitate to
e-mail me and ask. I wish you the best of luck! Steph :)
— squeekypete
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