Hey fellow OHers!

I had RNY in August 2008. I'm pretty active on the Pregnancy after Weight loss surgery board, as I had twins five months ago. I am also a student getting a master's in counseling psychology. I'm working on my thesis right now all about obesity and weight loss surgery, which as you can imagine is close to my heart. I need some volunteers to fill out some of my forms and tell me what they think. I can send them by e-mail and you can send them back. Please PM me if you want to help me out and increase awareness of obesity, weight loss surgery (any type), the stigma we face together being obese, etc. I really want to increase the awareness of our struggles and help convince the medical/psychological community that we have a voice!

PM me and I'll send you the attachment. I really appreciate your help!

Carrie

Thank you for the clarification.
I am new here (my first post!) and I am changing from GEHA because they require 6 months and there are more out of pocket expenses.

Hopefully the process with BCBS will go smoothly.

Hi All,

I too have the UHC Choice plus plan in Georgia. We do have a law on the books but that does not guaranty coverage. I wrote a letter to the State House of Representatives and Senate Insurance Committee and Health and Human Services committee about the issue with the word "may" in Georgia's law. I copied the State Insurance Commissioner and have been dealing with them for a couple weeks now. Here is what I have learned.

1. There are 2 types of insurance plans and each type is governed by different laws and government agencies.
        Self-Insured plans - are plans where the company pays all of the medical expenses and can override any decision. The insurance company on the card for these plans is just the paper pusher or administrator of the plan for the company that you work for who is paying the bill. Self insured plans are not governed by or covered by State or Local laws as they fall under a federal law written in 1974 (I believe) and they are governed by the Department of Labor.
*Most Large companies are self insured. 
       Fully Insured plans - are plans where the company pays a monthly premium to the insurance company to insure their employees. The Insurance company writes the policy and governs it. The company has no say in what will be approved on appeal. The company has to purchase a separate rider for WLS for the plan that we have as it is a fully insured plan. Fully insured plans are governed by the state insurance commissioner and state and local laws apply to them. Most small companies (200 or fewer employees are fully insured)

Here is the dozy, UHC is claiming with the insurance commissioner that our plan is self insured. My HR representative has told both me and the insurance commissioner that it is a Fully Insured plan. I am waiting to hear back from the insurance commissioners office on how to proceed, but I have written an appeal letter and have it on standby. If UHC continues to state that it is a self insured plan, I am going to ask my HR rep to write a letter stating that the company approves of me having the surgery and include that in my appeal.

We can win this fight! We just have to arm ourselves with all the knowledge we can!
I am still waiting to see what comes from all my state representatives about my request to amend the word may to SHALL!

 Approved! 

DS surgery
44 BMI
No Co-morbids
no 6 month diet or 5 year history

Other than the drawn out wait, it was easy!


Anthem BCBS PPO out of CA
Husband's company is self insured with Anthem managing care

ok cool, I was wondering why my wls center wanted me to do mostly all my pre-op test! maybe they will submitt my information too, how do you find that out? do you think i should ask the insurace company (medicaid) or the wls center?

:) aisha <3