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HW: 274 | SW: 232 | CW: 137 | Goal: 145 (ticker includes a 42 pound loss pre-op) | Height: 5'4"
M1: -24 (205) | M2: -14 (191) | M3: -11 (180) | M4: -7 (173) | M5: -7 (166) | M6: -8 (158) | M7: -11 (147) | M8: -2 (145) | M9: -3 (142) | M10: -2 (140) | M11: -4 (136) | M12: -2 (134) | M13: -0 (134) | M14: -3 (131) | M15: +4 (135) | M16: +2 (137)
I'm APPROVED!
First submission with BCBS Federal. BMI > 35 with hypertension, mild apnea and a host of other comorbids that aren't in the bariatric trinity (Diabetes,hypertension,apnea).
I just want to say.. UP YOURS NALC!!!! (they denied me last year, would not forward my file to Cigna, and would not look at my clnicals quote on the phone.. .. "you're just taking blood pressure medicine"). I did get a sleep study after their denial to confirm mild apnea as NALC complained ... "you just have snoring.."
My advice to federal employees seeking this surgery with a BMI < 40.. stay away from FEHB insurance plans that have a middleman between the company and their underwriting insurance.. you will only wind up with two layers of bureaucracy to slog through to get approved.
on 1/18/13 2:17 am
I understand wanting the BLIS but a COE doesn't mean the surgeon is good. It really means they have a policy and procedure manual with all the right words in there. Some of the biggest bariaric butchers are COEs. Some of the best surgeons are not.
on 1/18/13 2:16 am
If it is excluded, they really mean it. WLS benefits are an additional premium for your employer. If that premium (rider) is not paid, they won't pay for your surgery.
MX can be a great option for self pay if you do your research.
on 1/18/13 2:12 am
Private insurance does not pay for WLS. They would go broke if they did. People would get a policy long enough to have them pay for surgery and then drop the policy.
Have you considered self pay in MX? Most people are self pay because most people do not have WLS benefits.
Pretty much all ins co's offer WLS, it's up to the employer to pay the additional premium for the WLS rider. It's very expensive.
on 1/17/13 12:18 pm - Las Vegas, NV
Hi everyone
Asking for some help here. Basically here is the scoop. I had the Band in April of 08, but lost my insurance in 2010 and havent been able to get adjusted since then, I have gained some weight back and I am sure its because Im not adjusted correctly. My fiance is also trying to get surgery as well. She has Cigna I Have Aetna. Aetna has a written exclusion against ANYTHING having to do with Bariatric surgery. She has Cigna, which OVERALL covers the surgery HOWEVER, her employer Knowledge Universe (Kindercare) has an exclusion written in their policy with Cigna. So we are seeking to find ANY private insurance in Nevada that will cover the surgery (possibly in Texas as well as we could possibly move if need be). I know how much the surgery can help (i lost over 120lbs at my peak) and I want that same thing for my fiance. Anyone with any help would be greatly appreciated.
Thanks
Marc
on 1/17/13 12:09 pm - Las Vegas, NV
Hi there
I was approved and had surgery in 2008 Lap Band.. I used and suggest you call Surgical Weight Control Center http://www.surgicalweightcontrolcenter.com/ 702-313-8446 I had Dr Soong do my surgery and totally recomend them, they will help you every step of the way, help with your insurance co, doctors pre op testing etc..
Hope this helps
Marc
There was an exclusion on my policy too and after spending $800.00 on a Wls advocate it was still an exclusion and I sell paid in mx. Save that money for self paying. There is no way around it. Because your employer didn't buy the rider for Wls so the ins isn't going to pay for something your company hasn't bought,right?
Gl
Hockeymom87 · 0 replies · 727 views
