Question:
has anyone heard blue cross blue shield will no longer cover wls?
i do not have Blue Cross Blue Shield as my ins carrier but my brother does and he told me that he had recieved a letter from stating that they will no longer cover "Gastric Bypass" and that being "Obese" was the individual,s choice, therefore they would not pay. has anyone else with this Ins recieved such a letter? if this is true, this is so cruel.i would appreciate your feedback. patricia [email protected] — patricia M. (posted on April 8, 2003)
April 8, 2003
I got that same letter an i think or hope that we will be able to see other
dr. that will preform the surgery.just not
bariatric centres. thats whats i was told when i called after i received my
letter. but we have to find are own dr.
please if anyone else heard something else please post what you heard
because Im tring to find a dr. an center now
— zarconai T.
April 8, 2003
I have Horizon Blue Cross and Blue Shield and they cleared me for surgery.
I have never heard of them saying no and being that cruel. I will
definitely look into this and let you know if I start to hear the same.
— Caroline S.
April 8, 2003
I have bcbs ppo of IL and was approved just this January. Is it possibly
the individual policy for your brother's employer?
— ChristineB
April 8, 2003
Remember that Blue Cross/Blue Shield is not one company. It is many and
there can be more than one version in a single state. I have Anthem BC/BS
of Colorado and they paid for mine, although I had to jump through some
hoops first. The only way to know for sure is to contact your individual
BC/BS carrier and see what they say.
— garw
April 8, 2003
Hi....although I don't have BCBS I think I just heard where BCBS will not
be covered at BTC's anymore. Something to do with BCBS wanting to pay less
for surgery and they can't agree. Hope this helps.
— hawk4life
April 8, 2003
Hi, I have Blue Cross of CA POS (HMO and PPO) and had no problems. I was
approved in February '03 in less than a week and had a surgery a month
later. My surgeon and hospital are part of the PPO Network so I had to pay
10% up to 3K out of pocket max and 250K annual deductable. It does seem
every case is different I have a friend with the same plan who is having a
terrible time getting approval. Also, my surgeon's office handled the
entire approval process with BC, that may have been the key to a smooth
process. Take Care and best wishes, Liz
— Liz B.
April 8, 2003
Every BCBS is different. What state is his plan from? I know that Florida
had stated last year that starting this year they would no longer cover it,
however, they have not filed anything with the DOI yet and they will have
to give a 90 day notice to it members.
— Sharon H.
April 8, 2003
I have BCBS ppo (Anthem) of Ohio...I was approved in Jan for RNY. I'm
scheduled for this month (April 23) I just recieved my approval for my
hospotal stay..I'm going for pre-op tests this Fri. I' had NO problems
getting approved for this surgery and and SO ready!
Also my policy renewed in Feb and was worded basically the same but left
out the Morbid obesity part. Its still covered. Morbid obesity and obesity
are totally different when talking inurance stuff. If there is no mention
of Morbid obesity in his letter he should call them at find out the policy
for MORBID obesity.
— Jamie M.
April 9, 2003
I have BCBS Texas and I also work for BCBSTX. While it is true each plan
is different what matters most is the group contract. Some contracts
override what any BCBS plan dictates because it is an approved benefit
written into the group contract. If no special benefits is written in the
group contract then it will fall into two categories. The first is simply
a not covered benefit. The second and this is the most important, it falls
into medical necessity. All of the surgeons know this fact. The best way
to find out is to either call BCBS or have your surgeon send in a
pre-determination for approval. Texas does not pay for Lap Band but does
pay for RNY or VBG with medical necessity and if not excluded by the group
contract. Medical necessity usually falls under must be at least 100 lbs
overweight according to insurance standards and have comorbities which
means additional life threatening medical problems besides being big and
miserable such as high blood pressure, diabetes, circulatory problems,
GERD, incontinence, sleep apnea, depression as well as others. Good luck!
Alma
— Alma W.
April 14, 2003
Patricia, I've not heard that. I had my surgery last year in September, and
pleased at all BCBS of Georgia-Federal: Standard-PPO (formerly High Option)
paid. I had the LAP RNY Gastric Bypass. If they told you that, someone is
LIEING TO YOU!! Obesity IS NOT an individual's choice!! Demand to see that
in the policy. Fight it if you have to!! That makes me so angry for them or
anyone to say that. Obesity is a disease and can be a DISABILITY!!Make sure
you have medical records from all of the doctors you have ever seen listing
ALL of the co-morbs!! The very nerve of them trying to prevent your brother
from living and enjoying his life free from pain and agony. To be on the
safe side, be sure YOU go over his policy, but don't give up!!DON'T take
this lightly and DON't settle for this *flaky* letter!! It's crucial that
you go higher with the letter. Go to the Medical Committee of your BCBS,
call the insurance commissioner in your state. Go to the mayor, Department
of Health & Human Services, your local newspaper...THE MEDIA even, but
by ALL means F-I-G-H-T!!email me if I can be of further assistance to you
at: [email protected] McCutcheon LAP RNY 9/3/03 265/165/115,
a.k.a.~~~
— yourdivaness
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