DENIED...and Im sad

I called my surgeons office to see if BCBS of Fla approved my surgery. I spoke to April in his office who said that she had not heard anything yet which is a good thing. She said if they were going to deny it it would happen the first few days. She submitted it last Monday. 30 min later she called saying they denied it. She said that my Florida Blue policy does not cover WLS. I called them before I started this and they said it was a case by case basis. They said under no cir****tance would they cover it because it is not in my policy. I asked about appealing but April said that thy would most likely deny again since its a non covered surgery. SO NOW WHAT????? Where do I go what do I do? Does anyone have individual insurance that paid for it? Ugggggh I am an emotional wreck now.

I'm so sorry this happened.  Its awful that they don't cover WLS when it really is medically necessary for people who are obese.  I just hate insurance companies.

A lot of people here did the surgery self-pay and many travelled to Mexico quite successfully.  Hopefully, you can find an alternative that will work for you.

best wishes,

Carol

I had the same issue with Florida Blue - after speaking to several people who confirmed that the surgery would be covered if medically necessary, when my PCP gave me the referral, Florida Blue stated that my policy specifically EXCLUDED surgery.

Eventually, I found a reasonably decent price on self-pay, and had to go that route.

Wishing you better luck!!

It is not the insurance company who doesn't cover the procedure.  It is your employer.  Talk to someone in your benefits office and ask them about this coverage and whether or not it is covered under their insurance.  Then you will know for sure.

Jane

You might have a choice of different insurance plans during annual sign-up.  If so, you could check those other plans.

I was originally on my wife's plan because it was slightly cheaper but their approach to WLS was a MAJOR hassle.  I opted to switch myself back to my employer's plan which was much easier to deal with.  It did mean I had to wait for open enrollment to come around though.

Failing all that, the Mexico route (weird as it seems to me) seems to have worked very well for many of the people here.

In the end, if I'd had to go self-pay, I would have really been hesitant up front while looking into the unknown and not know if it was worth it.  With hindsight now, I'd happily have paid the self-pay rate for what it's done in my life.  I know this option can present some real financial constraints, but if it's at all possible, I swear the benefits are worth the cost.

I actually no longer work for the company. I am on Cobra now. I am going to research the Mexico option. That sounds about the best option at this point. The full price for the sx here is $18,000 which is not bad considering some places it is over 30. Thank you guys for your support. Hopefully one day I will be able to post that I had it done.

Where in FL are you? My surgeon's self-pay was around $13,000.

I am in Clearwater, about 30 min from Tampa.

In Harrisburg pa ....... 8900.00