BCBS

Has anyone had success in getting BCBS to pay for surgery?  It says it covered, with certain conditions.  I'm not in those categories yet (diabetes, Hypertension, etc) but if I don't do something I will be.  I do have an underactive thyroid controlled by meds.

I have BCBS and had my surgery may 21. I did have comorbidites however i do know with BCBS that if you have no comorbidites if your bmi (if I remember correctly) is above 40 you will still qualify for the surgery. There is the 6mo supervised weightloss etc but hope that helps :) 

All BCBS plans may be a little different.  I had surgery with BCBS coverage.  My BMI was over 40 without co-morbidities, so they covered it.

If you have aches & pains, chronic low back pain/knee pain - those count as issues too.

My husband's BMI is 38 but he is diabetic, so they are covering his too.

BCBS covers Wls but the PLAN your employer has bought may not cover it. You need to check with your plan administrator and find out if it is a covered expense. If it isnot a covered expense,then it is excluded and they will not pay no matter what. 

 We have BCBS and it is an exclusion because DH employer did to buy the coverage for his employees.

I also have BCBS but they are the underwriters for Educator's Health Alliance.  BCBS covers it but my EHA doesn't.  So I did self pay.  I took out a loan and will be paying for surgery for the next few years but my life will be better for it.

  I have BCBS of IL (PPO) I called them and they said it was covered as long as I use a Blue Distinct hospital.... (those held to a high standard). They told me since my BMI was high (over 40) all I needed was a consult with the surgeon. However my surgeon's office was wonderful they actually informed me that BCBS require Dietitian and Pysch eval....BCBS never told me that!!!! Make sure you have a great surgeons office, they are your biggest advocate!! They know all the ins and outs!

They submitted to my insurance yesterday.... so the wait begins!!  

Good Luck!

You won't be waiting long, Jessica!  I, too, have BCBS of IL PPO and was submitted for approval on Friday, June 27th and heard I was approved on Monday, July 7th. Now keep in mind weekends and that happened to be a holiday week too. I called BCBS on July 1st just to make sure they received the request and they were very helpful. They confirmed receipt of the request and went on to tell me that since it wasn't an urgent request (a life or death emergency) and a holiday, I probably wouldn't hear anything until the following Monday but feel free to call back. I didn't have to because much to my surprise the surgeon's office called to share the good news.  You'll soon be doing the happy dance! All the best!!

Oh great news to hear about your status and the speed!! Makes my wait a little easier. 

Thanks for the info!

jess

It really is employer specific. My particular plan is part of the BCBS network (Highmark) and while my ordinary benefits cover surgery 100%, they only cover 50% of WLS, no out of pocket maximum. I was told I was lucky because my employer could have elected to purchase a plan that excluded it altogether.

You really have to call and find out. They will tell you the conditions and requirements.

Hi Rhon1017, 

Call BCBS and ask them to check your coverage (my surgeon's office made me call as a first step before scheduling the consult - they do this partly so they know how to classify you - self pay/insurance & who will be your coordinator throughout the process). The BCBS rep explained the requirements and then told me where to find the written coverage policy explanation online specific to the procedure. As others mentioned, each policy varies by your state and employer's policy but all the info you seek is out there for you to grab. Start by picking your surgeon and get a good comfort level with all you see and hear about him/her online. If the surgeon is a 'Bariatrix Center of Excellence' then chances are the hospital he uses is a BCBS Center of Distinction. As other posters mentioned, this is VERY helpful in getting you approved as well as greatly lowering the chances of complications and providing you with a sound and safe program pre AND post op.

Good luck and Go Get'em!