Question:
Does BCBS PPO pay for the Verticle Sleeve?
Interested in the Vertical Sleeve — snowglobe (posted on January 9, 2010)
January 9, 2010
My BCBS of FL did not pay for any weightloss let alone something
"new" like the sleeve. My total out of pocket bill so far for my
surgery last week is $14,500. But I don't regret one penny spent. Katey
— Katey
January 9, 2010
my bcbs of pa. but i live in MI paid 100% for the sleeve, only stipulation
wasa supervised diet with dr. or nut. Good Luck!!!
— [Deactivated Member]
January 9, 2010
It was explained to me, that your Ins. is determined by your employer -
PERIOD. We also have BCBS of Alabama (live in Texas). I had a revision in
Sept., and my co-worker had RNY in Oct. She had been on Weight Watchers
for at least 6 mos., and was seeing her Dr. every month for 8 mos for
Cholesteral issues, so when she decided to do this, it was pretty easy for
her to get accepted. I on the other hand, needed the revision due to an
old version of the "band", that had eroded into my stomache, and
had to be surgically removed, so mine was considered a necessity. I wish I
could have had the sleeve, but am very happy with what I did receive RNY.
I have lost 56 lbs, in 4 mos. Probably could have been more, but it is
what it is...and I wouldn't have it any other way!
Best thing is to call BCBS, they have employee guidelines for each
policyholder that you can go online and read to see if they offer the
surgery, and what basic hoops you have to jump thru. Best of luck in your
endeavors, you can get this provided your employer didn't place any
restrictions to devoid WLS in their policy!
— Lisa1212
January 10, 2010
Lisa is correct. Whether or not your particular policy covers the sleeve
or any bariatric surgery totally depends on what benefits your employer has
opted to include in your coverage. You can quickly find the answer by
calling your benefits department and asking if bariatric surgery is a
covered benefit of your policy. Even if the surgery is covered, you will
have to meet certain criteria which they will also be able to explain to
you. BCBS Federal recently began covering the sleeve for federal
employees. Some companies still consider the sleeve experimental but will
pay for other types of bariatric surgery, much like the Lap-band was five
years ago. Best of luck to you!
— Bonnie H.
January 10, 2010
I am a Federal Employee, so My BCBS is FEP program, "Federal Employee
Program". This means that BCBS is held to the standards of all
federal employee insurance companies, no such thing as a "preexisting
condition" and so on and so forth. I had the Verital Sleeve procedure
and they fought paying it tooth and nail. After a year of appealing and
sending my final appeal to Washington DC to the Office of Personnel
Management, it was approved and paid. To my knowledge, this is the only
Vertical Sleeve procedure that they have paid on in Seattle.
— cydthekid50
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