This Sucks!!!!!

shellyj · 01-07-2004, 01:08 PM

i just found out that effective 1-1-04 our insurance changed to BCBS of TN and i am very irritated because there is an exclusion for "services and supplies related to obesity, including surgical or other treatment of morbidd obesity"

well if i just had to pay for fills that would be one thing but the more fill i have the more i worry about my actual band needing tightning. i have 3.8 cc and 3 weeks since that last fill it is really loosening up :think :think so since i only have .2 cc's left i am getting pretty nervous... my dr told me when banded ' dont worry i put your band on a little loose' like that was supposed to be comforting!!!! DUH~ i want the band to be tight!!! anyhow it has been almost 5 MONTHS and i have some restriction but as i lose and my band loosens up i dont have much room for more fills... if i have to have a revision to tighten my actual band would i have to 'sue' the dr to not have to pay for the entire bill myself?

i am not gonna get a fill for a while because i think i can lose on what i am eating now~ but what the duck an i gonna do when i am at fill capacity!

;) sorry to any ducks i may have offended;)

kellymoos · 01-07-2004, 02:26 PM

That really does suck! Your company did not tell you that your insurance was changing? I am sure if you had to have another surgery regarding your band they would have to cover it, it is to fix something not the original surgery. I would not worry about it cause you may not have to ever have another surgery and all this time you are spending worrying you could be partying!! Take care and smile!!! At least you got the band before your company changed insurances.

shellyj · 01-07-2004, 03:04 PM

Quote:

At least you got the band before your company changed insurances.

well kelly you have a great point there! i hadnt even thought of it that way! i am going to call when i get some time and find out the deal from the ins co.

i also need a swallow study done (i am waiting on a call back from the dr) i think my band is fine it is just LOOSER than it should be. it was tight at first but has loosened up some over the past 3 weeks. i dont want to get anymore because i am afraid it will mysteriously tighten up on me.

GracefulOne · 01-08-2004, 12:26 AM

Shelly,

You should check with your HR department and make it a point that they cover treatment as you already have been banded. I think that type of change in insurance coverage only applies to people starting the banding or WLS journey.

What you have now is maintanence...or a pre-existing condition persay that legally should be covered.

**Alexandra** · 01-08-2004, 07:03 PM

Shelly, Jennye has a good point. You should ask your carrier about ongoing treatment for a current condition; I don't think that can be excluded from a new policy. Even if the carrier tells you it can be, you should place a call to your state department of insurance and ask that same question in general terms.

They may tell you that it's just not covered, but I'd think it's worth finding out the applicable state regulations so you know if you have grounds for an appeal. Good luck!

Leannie · 01-08-2004, 10:44 PM

Shelly:

Are you in a union? Some contracts say that if the employer changes insurance contracts, they are obligated to get you AT LEAST comparable coverage or better.

shellyj · 01-09-2004, 05:45 PM

thanks ladies for all the great info. i am going to call bc bs right now and see what they say.

i have to wait till first week of feb for them to check the band.

shellyj · 01-12-2004, 01:43 PM

well i just got finished argueing with BCBS and they are 100% positive that even if i have to go to the ER to have my band removed that it would not be covered by them. if it is related to the band it is not covered.

shellyj · 01-12-2004, 02:06 PM

also i just told my boss what i found out and he said 'humph you could fight it' and walked out. his wife had gastric bypass gee if she needs a revision she wont be covered either.

i thought that was rather rude for him to not care.

i did email the state of TN insurance dept. and ask them so we'll see what they say.

i guess i'll have to pay cash $$$$ for my barium swallow.

michelle