BCBS AL wont cover- feel hopeless

I have spent almost 6 months getting all the tests and paperwork together and I have been denied. My doctor had written a note of support and I had documentation of several comorbities. I also have several herneiated disks in my back which my dr has claimed would improve tremendously with weight loss. I was denied because I did not have 6 months of documented weight loss within the last 6 months concsecutive even though my Dr included all my weight loss attempts for the past 5 years!!!

Ok here is the question, I have left my employer and will now have BCBS NC does anyone have them and are they any easier to get an approval from. I feel so depressed and hopeless- it never occured to me that I would be denied because I had everything in order. If anyone can help me or give me advise I would really really appreciate it!:help::think

First, call BCBS NC and ask. What one person may have as coverage, you may not. Insurance comapnies offer different types of policies, some do not include a weight loss surgery rider.

Second, START THE SIX MONTHS RIGHT NOW. The six months you spent getting everything together could have been the six months you needed. I had to do 12 months and was denied the first time around and it was 15 months until I was banded. You need to have monthly weigh-ins and DOCUMENTED discussions with your provider about what you are doing for weight loss. You cannot miss one single month.

Get to it.

When I had to do the 12 months, I was understandably depressed, but I didn't gain this weight in 5 months or 12 months, it took me years.

Another option is to self pay.

Good luck!

I also have BC/BS of TX HMO and they do not cover it at all. (with or without documentation). I feel the same way you do. MY husband even works for BC/BS, and he can't even pull any strings for me. However they will cover Gastric Bypass. One would think they would cover the safer and cheaper surgery. His (my Husband) suggestion to you would be to join weight watchers or Jenny Craig, they have a Dr.s note you have to have singned. Stay involved for 6 months with regular visits with your DR. documenting each time that you are involved and this should work for your 6 month weight loss requirement. Good luck

When BC/BS asks for 6 consecutive months you need to give them exactly what they ask for - there is no way around it. When they say consecutive they mean consecutive. I was approved with BC/BS after eleven months. I had everything in order after six months but then they kept asking for more and more specific documentation. My doctors helped me obtain the particulars they were seeking and finally they approved the surgery. You HAVE to jump thru all the hoops they ask of you. You CANNOT give up! In a way I think they hope that you will get tired and give up because then they don't have to pay - don't play into that game. Jump, Jump, Jump! You will be so happy when you get that approval letter in the mail. Don't Give Up!!!

Make sure your current employer does not have an exclusion for WLS. I have BCBS of AL. They are a stickler about the 6 months thing. my was 6 months in last 2 yrs and only 3 months of consecutive. it could be from weight watchers, curves, dietitician (not from surgeon office), or primary physician but had to state weight and discussion of diet and what to do ex. exercise, low fat, low carb or 1200 calorie intake..on every visit report.
Now..i believe you will find the same stipulations from your new insurance also. Mine had to go through SHIPS before being approved by insurance and I had them tell me exactly what they wanted.
Hope this helps
Peachy

Why isn't your surgeon making use of the FREE Lap Band Appeals program? We can assist you with appealing to BCBS AL and/or BCBS NC - having had success with both! You should talk to them about that program.
Walter Lindstrom
Lap Band APPEALS ADVOCATES (A PROGRAM OF Obesity Law and Advocacy Center)

I'm so sorry for your struggle. I started my journey in January; that was right around the time that BCBS started to accept this procedure as a valid weight loss treatment. I was on the cusp. Fortunately, my surgeon's office is within a hospital and they did all of the corrospondence with the insurance company. I guess that was a huge help. I also knew that I had to have my primary care doctor make the call to the Lap Band surgeon's office; it wasn't something that I could just make an appointment for myself. See if you can find a surgeon whose office takes care of all the insurance stuff. They know the loopholes and the shortcuts and have lots of experience doing this sort of thing. Hope some of this helps. Good luck to you. Barb