Blue Cross Blue Shield?

Cait C.
on 7/13/09 8:40 am
A friend of mine is considering the bypass.. does the blue cross blue shield cover the procedure?
L. Rios
on 7/13/09 9:39 am - Springfield, MO
I have BCBC of California ( even though I live in MO) my husbands company he works for is a Cali based Co and it covered mine. I got to go to Columbia too.  I just had to get a letter from my PCP of medical necessity and then they required a psych eval, sleep study and a visit with a nutritionist.  After we got all that submitted they approved it in less than a week.  Good luck to your friend. ;) Lou
L. Rios
on 7/13/09 9:40 am - Springfield, MO
oops BCBS sorry
on 7/13/09 1:16 pm - MO
Coverage is determined by policy not by insurance company. In other words it all depends on if the employer who provides the insurance to their employees has an exclusion for bariatric surgery or not. It is cheaper to have it excluded than covered is why so many don't cover it. She needs to call her customer service number on her insurance card and ask if it is covered in her policy.
Good luck I have BCBS and it was covered but my husband works for a very large company with excellent benefits.
Connie B.
on 7/21/09 4:59 pm - Blue Springs, MO
Yep,it varies on policy.  I have a plan through BCBS of Minnesota. the regulations are:

1. BMI of 40+, or a BMI of 35+ with at least one comorbidity
2. Documentation of obesity for at least 2 years
3. 6 months minimum on a Dr. supervised diet
4. visit with psych and nut. before surgery.

In addition, our plan requires you to have the surgery at a "Center for Distinction". In KC we have KU Med and Shawnee Mission Med. There's also Columbia and three hospitals in the StL area.

My PCP is appealing condition #3 for me based upon scientific studies related to my personal situation. We'll see how that goes :) 
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