Question:
What is anyones experience with BC/BS of Georgia?

Hi, i am covered by BC/BS and by the blue choice hmo. I think the hmo excludes WLS but I was wondering about BC/BS. The policy is through MARTA in atl. and we have never had any problems from the before. I would love to hear your experiences with this company    — Jami H. (posted on June 20, 2001)

June 20, 2001
Hi Jami, I also have BC/BS Bluechoice HMO. Do not let them fool you. They do cover weightloss surgery if it is medically necessary. When you apply for approval you have to be very careful in how you word it. They won't pay for it if your diagnosis is obesity. However, they will pay if your doc says you need it due to co-morbidities. My husband and myself were on the phone everyday at least 5 times a day trying to get them to admit that they will pay for it. It's all in how you word it. We called so many times that the VP of Bluechoice HMO called me personally to apologize for the run-around customer service had given us. This was also when I was trying to get approved for my Phsyc. Eval. She approved me on the spot and asked if I needed my referal # for surgery. I told her that Dr. Procters office would contact her when it was time to send in for an approval. (you have to go through their program step-by-step. She said No Problem. I guess the only way there could be an Exclusion is if your employer has it. You may want to check with them.
   — Melonie K.

June 20, 2001
Each policy is different; however, my policy did have the exclusion but my employer (Fulton County) agreed to go outside the contract and pay for it. If presented correctly to Marta I believe they would do the same for you. I went to the empoyee benefits supervisor and she presented it to the Director of Finance. After consultation with BlueChoice they agreed to pay for it. See, BlueChoice does NOT want to get into a situation where they say that it is NOT medically necessary because that makes them liable so if your surgeon writes it up the right way - claiming medical necessity your employer should jump on the band wagon. They don't want to be liable either, I'm sure. Good luck!
   — Sharon R.

June 21, 2001
Thanks Sharon! My insurance is also through Fulton County (the Health Department)I would love to hear about your experience with the county and I would also like to know what doctor you used. If it's not a problem, please e-mail me at [email protected] and tell me more specifics about your case.
   — Jami H.

December 24, 2001
Hi all, I just wanted to update and let you know that after about six months of battling, I have finally been approved and will be having surgery on 1/11. It took two appeals and the aid of my mother\'s company, but I did prevail. So if anyone else is having the same struggle, please keep the faith and good luck!
   — blank first name B.

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