BCBS of Alabama has added the DS to their policy!!!!!!

Aug 12, 2009

 I have been a lurker on the forum for months learning about the DS, what to expect after surgery, what to eat, what to avoid, vitamins - you name it.  Thanks to everybody for all of this information and especially to the people I PM's for information to aid in this process.

While I have been lurking - I have also been fighting the big fight with BCBS of Al.  I  was denied.  I contacted our company since we are self-funded and asked them to support my decision for the DS.  I sent volumes of information - LeaAnn's lawsuit, research that has been posted, anything and everything I could find - I forwarded on to justify the DS and to show it was not  "investigational".  

Our company attorney was impressed with the information and did some research of his own - calling surgeons, etc and agreed that the DS is not investigational.  He then contacted our corporate office and asked those attorneys and the head of Human Resources to contact BCBS of Al.  They did - and after several months of going back and forth - I  received a draft today of BCBS of Alabama's new policy.  They did add the DS and I am thrilled that this has been accomplished.  

Now the bad news.  BCBS is requiring a BMI of 50 or  greater to qualify for this surgery.  I will not qualify.   They speak of the danger of malabsorption as being too dangerous for people with lower BMI's.  They also sent me copies of the research they have to support this theory.

Again, I will be fighting this battle.  Would I would like to ask is the following:

If you have BCBS insurance and got approved for the DS, would you please contact me telling me telling me the state in which the policy was generated?    What was the BMI requirement?  Did you have to fight for the surgery because  their BMI was lower than 50 - and if so, what was your BMI?

I also would like to know about other insurance policies that approve or have been beaten after a denial due to an outside source.  Alabama residents have no recourse after a denial other than suing.  There is no independent board we can go to get out denial overturned.  I want to let our attorneys know how many insurance companies cover the DS (and at what BMI level) and how many were able to get approval immediately or after an outside source ordered the insurance company.

I also would appreciate if anybody can offer information regarding the DS being successful for people with lower BMI's. I need this information as soon as possible as I am going to try to get BCBS to change the BMI level in their draft.  Maybe not possible - but I am not giving in.

If anybody wants to read a copy of this draft (it also has research attached as a justification for their position), I can fax it to you if you send my your fax number.  I don't know how to post it for reading - if I did I would do so although it is quite a few pages.

FYI - I was told BCBS of Al was changing their policy to support National BCBS's new policy.  I am hoping this means that all BCBS entities across the US will also change up their policies but I do not know.  I find anything and everything BCBS has communicated to me to be generally not true.



If someone wants to post this information on other boards - please feel free to do so.  Hopefully, this will help someone who might be getting another surgery because BCBS of Al has never covered the DS before.

Thanks for your help.  

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