Question:
HELP!! We have bcbsnc blue care AND dh's company is self-insured!

Please take a moment to read this from my bcbsnc booklet and keep in mind that the comoany my dh works for is also a self-insured healthcare company...please let me know if you think I will get an approval...here is what it says: Your health benefit plan does not cover services, supplies, drugs or charges that are: For treatment of obesity, except for surgical treatment of morbid obesity. The reason I am so anxious is because the company had another insurance plan last year with an exclusion-so naturally I was denied...I appealed and was denied after having gone through the HR dept AND the medical advisory board...I have a BMI of 45 with type II diabetes, high cholesterol, high blood pressure, GERD...even knowing all of this last time, I was still denied...so what do you think?? I appreciate your time in answering, and thanks again!    — doit 2. (posted on January 2, 2003)

January 2, 2003
Stop worring...it says it right there...except for surgical treatment of morbid obesity. That means it is a covered benefit. What you need to do is call the insurance company and ask for specifics. Do they cover ALL surgery costs associated with the surgery? What are the requirements? Are comorbids required? Is Pre authorization required? Is a referral necessary? etc. Being a former employee of a couple of self-insured medical insurance companies most DO cover this procedure.
   — Robin J.

January 2, 2003
I have BCBS Personal Choice and I think my policy is somewhat like yours. They covered me 100% and it only took a day to get approved and alls i needed to have was a BMI over 40! Hope this helps!
   — sandrac131

January 3, 2003
My booklet says the same thing as yours. DH is a postal employee and has Fed BC/BS PPO. I called them and they said as long as the doctors say it is medically necessary Everything is covered. Even the tests we have to go through, such as sleep test, psyc exam and so on. I wouldnt worry much if I was you. Good Luck!
   — TheresaC

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