Clarification needed

Sida · 06-26-2008, 07:59 PM

Hi all! I've been a lurker for awhile and have been browsing this forum. I meet the criteria for lap band, but my company has an exclusion for WLS under BCBS in Georgia. I've seen several people who have won appeals, and I need to know whether you can appeal an exclusion or if the appeal was just because the insurance companies covered WLS but didn't want to approve it right away for whatever reason. I'm a little confused on the formalities. I really can't afford to pay out of pocket, but I think there may be a chance for my insurance to cover it from what I've read here. I would appreciate any help so much!

Mink · 06-26-2008, 08:09 PM

Exclusion in 99% (or more)of the time means the end of the road for insurance paying you can do what I did and shop for a doctor for self-pay.
My company has an exclusion but we did get them to cover pre-op tests.(they did not cover them for my surgery but my reflux)

Sida · 06-26-2008, 08:13 PM

oh boy that's depressing. Thanks for the info though, I appreciate it!

Chunkymonkys · 06-27-2008, 04:59 AM

Sorry to hear about your policy :( I have worked in the insurance field for a long time (BC being one of them) and when you have an exclusion on your policy, there is no way getting around it. Applealing does no good. Once it is written into your policy, that's that sadly. Your best bet is to go to your employeer benefit person (you know, the one that no one really knows but writes up the policies) and ask them if they are going to consider covering it in the future. It will probably be futile, but what do you have to loose right? I ended up changing jobs to get mine covered lol.

Sorry to be the bearer of bad news, but I didn't want you to have to go thru a bunch of hoops to only be crushed at the end of a long drawn out battle.

Good luck!

nip50 · 06-27-2008, 06:50 AM

Sida - Sorry about the insurance. I also have BCBS of GA and they're correct. No way. The only way they will pay is if the company you work for paid extra for a waiver to cover weight loss surgery and so far, I haven't heard of any company that has done that.

What part of GA are you from? I'm down south in Douglas and was banded in Albany by Dr. Bagnato, self-pay of course. I had part of the money on hand and borrowed some from a relative. Can you do it self-pay? It is so worth it. I don't regret it for a moment.

Sida · 06-27-2008, 09:39 PM

Thanks everyone for the helpful info. I'm in the Metro Atlanta area. Still deciding on who to go with, still doing lots of research. I will end up probably paying half cash and financing the rest somehow. I just got out of debt, I really don't want to do that again. But, it'd be worth it.