BCBS South Carolina won't cover iron infusions

[Tami7777]

I had the gastric bypass in 2009. Have had iron infusions in the past covered by a different insurance. My ferritin level is 5 and hemoglobin is just below normal. Can't remember now what it was. I just got a denial letter. This is what their policy says:

"Any treatment or Surgery for obesity (even if morbid obesity is present), weight reduction or weight control, such as
gastric by-pass, insertion of stomach (gastric) banding, intestinal bypass, wiring mouth shut, liposuction or
complications from it. This includes any reversal or reconstructive procedures from such treatments"

If anyone has any advice it would be gratefully appreciated.

 

[DianaCox]

What kind of insurance refuses to treat a pre-existing condition? Under the ACA, that should be illegal.

 

[Spiky Bugger]

And, what ABSOLUTE PROOF do they have that these lab results are the result of batiatric surgery? Anemia does have other causes...heavy menstrual bleeding, intestinal issues like polyps, stomach cancer, even hemorrhoids.

Hell, my BIL--who hasn't had heavy menstrual bleeding or bariatric surgery--has ferritin and HGB levels that are ALWAYS low; they do test after test, and can't find a cause.

In fact, by assuming that the bypass is the cause and not covering treatment, they could be discouraging you from finding "the real cause" of those lab results.

Not that I'm argumentative or anything.

And, hi.

Sue

 

[Larra]

Nothing in that portion of your policy says anything about treating a complication of your prior bariatric surgery, and that's aside from what @DianaCox said about not treating a pre-existing condition. And also aside from what @Spiky Bugger said about how there are lots of potential causes of iron deficiency anemia. You aren't requesting bariatric surgery, or a reversal of bariatric surgery, or anything else related to helping you lose weight, you are requesting treatment of a different medical condition. Maybe the problem is how your doctor coded the request - look into that.

 

[southernlady]

Sounds like your doctor screwed up the coding. What part of SC?

 

[DSRIGGS]

I hope you can get it covered but honestly to expect vitamins to be covered just doesn't happen with most insurance policies. That being said like pointed out if it was a pre-existing condition they should be covering it but who knows. I've never even tried to have my vitamins covered because I know you'll laugh at me and won't do it but again I hope you can get yours covered every little Penny helps

 

[Tami7777]

Thank You, everyone, for the replies I have an appointment with the social worker at the hematology clinic to figure out what my options are. It is definitely worth the fight but I just am barely able to function. Going to work has been very difficult and I'm gaining weight because unable to exercise.

 

[Tami7777]

Just an update on the verdict, For some reason my health insurance will pay for the administration of the iron but not the actual medication. (which makes no sense considering their policy which I copied and pasted in the above post) The drug company is going to pick up the tab because I fall within the financial income level to qualify for financial aid from them. I just need to hear back from them after they verify my income level.It won't come soon enough because I am so wiped out.

 

[Spiky Bugger]

Just an update on the verdict, For some reason my health insurance will pay for the administration of the iron but not the actual medication. (which makes no sense considering their policy which I copied and pasted in the above post) The drug company is going to pick up the tab because I fall within the financial income level to qualify for financial aid from them. I just need to hear back from them after they verify my income level.It won't come soon enough because I am so wiped out.

I had a battle this at one point with, of all things, Synvisc (for worn out knees.) The (greedy) ortho clinic decided that it was too expensive for them to store Synvisc on site and instead sent patients out with an Rx for the drug, which--because it was an expensive drug and needed to be administered (injection into knee) by a professional (usually under flouroscopy or with ultrasound) was not carried by local pharmacies or covered as a regular Rx drug.

So, I went to a different doctor. He still stocked the Synvisc and administered it and inurance covered the whole thing.

So...it might be a matter of coding, as well.

There are people here who are smart about such things. Let's ask them.

Meanwhile, needing iron may become a regular thing. You need to fight this if they are still claiming that they can deny covering anemia because you had bariatric surgery.

 

[Stefanie S.]

Sounds like you've already been given great advice and I don't have much to add. But I wanted to share that I am with BCBS, and although I find them to be a terrible company, they did and do cover my iron transfusions. I've also had to appeal other denials with them and you can win. Don't let them get away with being awful.