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10-20-2007, 05:54 PM
| #1 (permalink) |
| Whipper Snapper |  Please Help Me!!!
I am so upset, I have been without Ins since my husband changed his job about 4 years ago. I finally got insurance 2 months ago. BCBS HS plan. I live in Texas. My ins agent is a long time "friend". She came to my house and we filled out the paperwork. I was approved. When we were filling out the paperwork I asked her if the ins would pay for wls. she said that they would if it was medicaly ness. no problem. I was so excited. She has been a agent for bcbs for 30 years. Well. The first of this month I got sick, with the flu, went to the Dr, found out I have hbp and am diabetic. While I was there I asked the Dr about wls. He assured me that I for sure fit the med ness part. He got the needed paper work from the surgon, I filled it out, everything was great. I was a perfect canidate. Then the surg called and said that my ins wouldnt pay for it. It was under exclusions and limitations. This same agent also told me that there was no use for my husband to apply for any of their ins because he has hbp and is diabetic also. They would not approve him for any ins, except high risk. So now what do I do. So now that I have been diagnosed with these things will an ins co insure me? if so, what ins should I apply for? I am so upset, please give me some advice on what to do. |
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Yes, you can often get insurance cover for your Weight Loss Surgery. Our own Craig "Big-T" Thompson has been there and done that, and he's written an e-book about it.  |
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10-20-2007, 06:16 PM
| #2 (permalink) |
| Seasoned Veteran  Join Date: Jan 2006 Location: SOMEPLACE LONG ISLAND, NY
Posts: 6,795
Weight Statistics June 1, 2005 Start Date:
5' 5"
Height:
310 lb Start Weight:
167 lb Current Weight:
159 lb Goal Weight:
143 lb Weight Loss:
8 lb Lb Left to Lose:
46.1290322581 % % Lost:
Body Mass Index 51.5810650888 BMI Start:
27.7872189349 BMI Current:
26.4560946746 BMI Goal:
Weight Loss Method Roux en Y Gastric Bypass     |
((((HUG))))) sorry your going thru this and i have no advice for you at this time regarding this matter.
__________________ LISA  http://w5.photobucket.com/widgets/dy...164/fr1endly2/ LAP RNY Gastric Bypass  |
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10-20-2007, 06:25 PM
| #3 (permalink) |
| Seasoned Veteran  Join Date: Mar 2007 Location: Floyd County Virginia
Posts: 3,643
Blog Entries: 1 Weight Statistics September 19th 2007 Start Date:
September 19th 2007 Surgery Date:
5' 10"
Height:
363 lb Start Weight:
197 lb Current Weight:
170 lb Goal Weight:
166 lb Weight Loss:
27 lb Lb Left to Lose:
45.7300275482 % % Lost:
12/31/09 Goal Date:
Body Mass Index 52.0793877551 BMI Start:
28.2634693878 BMI Current:
24.3897959184 BMI Goal:
Weight Loss Method Roux en Y Gastric Bypass |
Ok. I dont know if this will help or not but.......call the insurance company yourself and ask if you have Weight Loss Surgery Benefits. Go from there. The problem you may have is you was not insured for 3 months prior to your new policy being in effect. If they really wanted to push it they dont have to pay for the High blood pressue or the diabetes for a year.They could call this preexisting if they can prove if you ever seen a Dr befoe for the same problems. This is a normal waiting period for new policys. Your insurance lady should have told you this. I personally would call the number on the card and let them discuss this with you. I hope you can get this approved. |
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10-20-2007, 07:58 PM
| #4 (permalink) |
| Whipper Snapper |
I am just so upset. This lady has been selling this same ins for 30 years, I just don't know why she did this. I told her right up front that I wanted to check into wls. I know what she is going to do though. She will say that I misunderstood her!!!! there is no way. I know what she said. If she would have said that there was no way that they would pay for it, I would have shopped around some more. This was Friday that I got this phone call, I can't get hold of her on the weekends. So I am stuck till Monday, if then to be able to talk to her. I am so MAD... I know someone out there has some information for me, PLEASE let me know what to do |
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10-20-2007, 09:30 PM
| #5 (permalink) |
| WLS Master Guru  Join Date: Jul 2007 Location: Tega Cay, SC
Posts: 878
Weight Statistics August 2, 2007 Start Date:
August 14, 2007 Surgery Date:
5' 7"
Height:
283 lb Start Weight:
163 lb Current Weight:
150 lb Goal Weight:
120 lb Weight Loss:
13 lb Lb Left to Lose:
42.4028268551 % % Lost:
Christmas, 2008 Goal Date:
Body Mass Index 44.3192247717 BMI Start:
25.5266206282 BMI Current:
23.4907551793 BMI Goal:
Weight Loss Method Roux en Y Gastric Bypass |
If I'm not mistaken, once you are insured by a company prior to having any "conditions" neither the company you are with nor another company can deny you insurance. However, if WLS is excluded in your current plan, is there not another plan that would "include" it with BCBS? I know a lot of people who have had WLS with BCBS -- so its not that the company doesn't pay for it, they do. The question might be do you have the right policy? Perhaps going on to the BCBS website and researching yourself would be helpful?
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10-20-2007, 10:01 PM
| #6 (permalink) |
| Seasoned Veteran Join Date: Apr 2007 Location: Mount Vernon, NY
Posts: 8,135
Weight Statistics all my life Start Date:
4/19/2007 Surgery Date:
5' 9"
Height:
260 lb Start Weight:
143 lb Current Weight:
160 lb Goal Weight:
117 lb Weight Loss:
-17 lb Lb Left to Lose:
45 % % Lost:
Body Mass Index 38.3910943079 BMI Start:
21.1151018694 BMI Current:
23.6252888049 BMI Goal:
Weight Loss Method Roux en Y Gastric Bypass |
msvickie and jill both have good ideas. i am one of the people who have BCBS. i was covered. i think its the plan not really the "brand" that is the issue. I would call the company directly and ask them specifically if this PLAN covers WLS. thats a start. in terms of the rest i have no advice im sorry. i have no experience working with insurance comapnies so i cannot tell you the ins and outs and what not. i just hope that everything works out for you. please keep us posted.
__________________ Anything worth having is worth working for!   KenyaR.  Lap RNY 4/19/07  |
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10-21-2007, 12:12 AM
| #7 (permalink) |
| Whipper Snapper |
Thank you all for the input, I went into the bcbs website, they listed about 15 plans that I would be eligable for, I went into each one of them and looked into the limitations and exclusions. They all said the same thing. I'm not sure how to put this to where everyone will know where I'm coming from, to be able to understand what I'm saying, but..... Is it ok to call the ins co and ask what policy do they have that will spicificaly cover wls? then say well, thats the one that I want. Then run have it done. (I know its not that easy, just an example) It would be like saying, do you have a life ins that would cover suicide, thats the one that I want. Then run commit suicide. I just don't see why the ins co would let you do that. But I have never had dealings with them before. I would like to know what would be the best thing to do before Monday. I would like to be able to do something as soon as possable. As far as calling the ins co, when I call them, do I tell them who I am? and that I want to have wls? so I need to change policys? I have put a call into my ins agent, but I know I won't hear from her till Mon or Tue. Again thanks for all the information |
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10-21-2007, 04:16 AM
| #8 (permalink) |
| Seasoned Veteran  Join Date: Jun 2007 Location: Jacksonville, Florida
Posts: 4,760
Weight Statistics July 21, 2007 Start Date:
August 6, 2007 Surgery Date:
5' 2"
Height:
287 lb Start Weight:
164 lb Current Weight:
140 lb Goal Weight:
123 lb Weight Loss:
24 lb Lb Left to Lose:
42.8571428571 % % Lost:
January 1, 2009 Goal Date:
Body Mass Index 52.4872528616 BMI Start:
29.9927159209 BMI Current:
25.6035379813 BMI Goal:
Weight Loss Method Roux en Y Gastric Bypass |
I would definately call the insurance co...each plan that is written is very differnt in regards to policy exclusions and limitations. Just like when you are on a company policy, it is up to the company that purchased the policy whether they want to include or exclude something. My first step would be to call BCBS and ask exactly what the limitations and exclusions are of this particular policy and then contact your agent and let her/him know what you have found out. Insurance is such a catch 22, and they are there to make $$. Sad but true. I wish you the best of luck!!!  |
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10-22-2007, 10:41 AM
| #9 (permalink) |
| Whipper Snapper |
Well, I just got off the phone with the ins co. They do not have any plans that cover wls in my area!!!!! I still haven't heard from my agent, can't wait till I do!!! There has got to be an answer out there somewhere. I just need to find it, any more suggestions? I'm still looking on the net to see if I can find an ins to cover it. Please someone in Texas let me know what ins you have that coverd it. Thanks again.
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10-22-2007, 10:48 AM
| #10 (permalink) |
| Seasoned Veteran  Join Date: Jun 2007 Location: North Texas
Posts: 4,628
Blog Entries: 1 Weight Statistics I've lost/gained my whole life!!! Start Date:
Aug 1, 2007 Surgery Date:
5' 8"
Height:
280 lb Start Weight:
139 lb Current Weight:
150 lb Goal Weight:
141 lb Weight Loss:
-11 lb Lb Left to Lose:
50.3571428571 % % Lost:
Summer 2008 Goal Date:
Body Mass Index 42.5692041522 BMI Start:
21.1325692042 BMI Current:
22.8049307958 BMI Goal:
Weight Loss Method Roux en Y Gastric Bypass |
Where in Texas are you? My surgeon's office is in Denton, and the bariatric coordinator there is PRO at getting this kind of thing pushed through! (she's VERY familiar with BCBS)
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