| 12.01.02 I got my package from BCBS Carefirst today to fill out for openenrollment wich is DEC. I heard that they can not deny coverage during an open enrollment. Anyway I am filling the paper work out now and sending it off. Wish me Luck. Oh and by the way I read something in my boyfriends policy manual (he has indiv coverage) it says on page 1 CFMI Mandates (10/01) benefits are provided for the treatment of Morbid Obesity through gastric bypass or other surgical methods........... I am so happy they better apv me.......LOL 12.02.02 Well sent out the papers today for indiv coverage with bcbs I also set up my consult with DR.V's office again. It is set for Jan 22 AT 11:30 I am planing ahead if I don't hear anything from ins company then I will cancel. 12.06.02 Hi everyone....Can't sleep again tonight....... Hi I am writing to you to see if I can get any information from you about Obesity and Individual Health care coverage. My question is, I recently applied to BC/BS Carfirst Maryland for Individual Health care. I noted that my weight was 359 my height is 5 5. I also marked on the application that I am having problems with missed periods and depression. Do you know if Health Insurance's do cover you with my specifics? Please read my story on my webpage at obesityhelp.com. Thank you for any information. BC/BS is also sending me a form for open enrollment period wich is this month they said they just sent it to me on Monday. 12.06.02 Called CFA today they have received my application for individual health care. They said to wait 10 days I will try to call on Monday. 12.07.02 tonight i got the package for b/c b/s open enrollment forms I am going to fill out tonight and send it off. 12.08.02 ok well the ins that I am going to be offered during open enrollment with b/c /b/s is b/c /bs ppn I was looking on the website carefirst.com and did a search for exclusions and also for PPN I found a lot of info. Thought I would pass it on. Look what it states :: http://www.carefirst.com/pages/providers/newsletters/bl/bl_nca_july_2000.htm Senate Bill 541 � Coverage for Morbid Obesity This law requires health insurers and HMOs to offer coverage for the treatment of morbid obesity through gastric bypass surgery or other methods recognized by the National Institutes of Health (NIH) as effective for the long-term reversal of morbid obesity. Insurers may not restrict access to surgery for morbid obesity based upon dietary or other criteria not approved by the NIH. Morbid obesity, as defined in statute, means: A weight that is at least 100 pounds over or twice the ideal weight for frame, age, height, and gender as specified in the 1983 Metropolitan Life Insurance Tables; or A body mass index (BMI) equal to or greater than 35 kilograms per meter squared with comorbidity or coexisting medical conditions such as hypertension, cardiopulmonary conditions, sleep apnea, or diabetes; or A BMI of 40 kilograms per meter squared without such comorbidity. (As used herein, BMI equals weight in kilograms divided by height in meters squared.) So my coverage is going to be 154.00 a month with a 1000.00 deductuble with ins paying 80% of in network and 60% out of network of the allowable charge up to 3400.00 out of pocket. So in total I will have to pay 3400.00 out of my pocket and they will pick up the rest at 100%. It is open enrollment now at bc/bs I am going to call on monday and find out if it is covered WLS that is and ask them to send me out and exclusion book. We will see what happens. 12.09.02 Called B/c B/s PPN and asked if the PPN coveres WLS surgery they said not for obesity.??????? They said that I will get package once I am in the system. Does anyone else have this policy? updated site today. 12-12-02 I got the letter back from my first request for the non open individual policy it states "After reviewing you application. I find that you cannot be accepted for coveragee in this program Our underwritting guidlines indicate that for a person of you height a maximum acceptable weifght is 176 lbs. It is important to note CF BC BS also offers an open enrollment program that is available without mrdicval revire. No medical questionaires or personal health statements are required for enrollment." I called them today to see if they got my open enrollment form yet they said No give it a few more days. Jan 3 ,2003 I deleted my old postings if you would like to see more information on me please go to my other website www.geocities.com/mywlsprogress Hi I guess I should tell you more about myself. I had my first consult on July 1, 2002 then switched jobs and had to change ins so moved my consult to August 1.2002 this is after waiting almost 7 months for my first apt and 6 months of researching. I was apv for surgery with Dr. V about 4 weeks later for Dec 9th on nov 5 I gat a call from Dr. V's office saying that the ins Co retracted THE APV and are denying coverage because of group exclusion. I began writing letters to ins and ins commissioner talked with the head of HR. As I was waiting for responses at work I was pulled into my employers HR office with my Director and was told on Nov 7th that they don't' feel I was trustworthy and will have to let me go, I failed to let anyone know how backed up my work was (such BS I told everyone they knew it) I was escorted out of the building with my stuff. I called Unemployment that day. I was finally apv my company did not want to give it to me because they say I caused finacial stress after I talked to the Unemployment lady she told me that she was going to apv my unemployment. (just more prooff that my company was in the wrong) My phone got cut off and I stayed at my moms f axing information everywhere 13 news, Lawyer,Head of Hr etc......I got no where my mom and I begged and pleaded with B/C they said employer can waive it But the employer said no because it was for self esteem blah blah blah. So I went into a deep depression. Now what was I to do. Luckily I read something about an open enrollment period for individual coverage that would cover surgery. I filled out the paper work and was denied coverage because of my weight and height ratio. I then found out I filled out the wrong paper work for the open enrollment this product did not ask medical questions. Well I was apv for the insurance coverage. It started jan 1, 2003 In the mean time I made another apt with Dr. V to get another letter sent to the new ins. My apt is Jan 15. My policy does have and exclusion on it. It states: *medical or surgical treatment for obesity,unless otherwise specified in the covered services *Medical or Surgical treatment or regimen for reducing or controlling weight, unless otherwise specified in the covered services I called the ins company and asked what they meant by otherwise specified in the covered services They said if it is med nec it will be covered. So here I am now about to get on another ride. If this does not go through I don't know what to do. I hope that Dr.V can give me the surgery ASAP. I mean some lucky person got my Dec 9th date I can only hope to be so lucky. I already got a letter from my psychiatrist stating it is important for me to have the surgery and I understand it all. It has been a long journey I can't wait to start the next ride on the other side. I don't know what to do about work I am now collecting unemployment I hope to have the surgery soon so when I am done I can go and get a job. Unfortantly a company I want to work for with a perfect position called me to set up an interview yesterday. I feel that I should hold on and see what dr.v can do for me........................ Any suggestions? Well that is my story...... For detailed information please see my other site at www.geocities.com/mywlsprogress *************************************************************** January 30,2003 Hi I am back..... I had my consult with Dr. V on Jan 15th it went well I gained 15lbs now I am 374 lbs..YIKES... Anyway Dr. V is going to send out my letter I called this week and they said it is on its way by the end of the week. I hope to hear soon. I will call the dr.s office again on Feb 15 th to check the status I hope to hear soon what happens. Wish me luck. ******************************************************** Feb 4,2003 Hi everyone, I just wanted to let you know I called Carefirst today and they told me that the surgery will and will never be covered under my plan. I am upset. But what can I do? I just wanted to let anyone out there to know that I will not be having the surgery and I wish you all the best of luck. Damnnn Carfirst.............. maricha you can email me at [email protected] or [email protected] If anyone knows someone who is hiring and they offer benefits that cover this surgery please let me know. I am looking to work from WEstminster to Baltimore city. Thank you for you help. I trully hope everyone has better luck then me. **************************************************************** 03-04-03 well I got the letter today it says The Plan cannot provide a benefit for the requested service because: The member does not have the benefit for gastric bypass surgery. Therefore the plan cannot accept financial responsibilty for this service. Now my exclusion says: 14.medical or surgical treatment for obesity,unless otherwise specified in the covered services 15.Medical or Surgical treatment or regimen for reducing or controlling weight, unless otherwise specified in the covered services No where in the book does it say Gastric Bypass or WLS. It says I have 60 days to appeal. Now what? |
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