Question:
I know that Blue Cross is going to stop covering wls surgery
after 1/05 but my question is this... Is it going to be harder to get approval between now and then? My fiance has blue cross blue care and i am wondering if after we get married this month would it be worthwhile to get added to his insurance to try to get approval... Any luck out there??? — Sharee *. (posted on May 7, 2004)
May 7, 2004
In my opinion, it could not hurt to have secondary insurance available to
you. I am sure that most will tell you that every BCBS policy is different
so you may or may not meet any obstacles. I was just approved with BCBS
recently and originally thought I would not be able to have the surgery
this year based on all the hoopla surrounding BCBS changing their
requirements. My surgeon sent the first letter requesting the surgery
01/05/04. I received a letter at the end of January saying I needed to show
12 months worth of supervised diet history and nutritional counseling. I
was so stressed out about it and it was at that time I started a weight
management program thru my surgeons office. I was originally told that I
should undergo a supervised diet and nutritional counseling for 6 months
and then resubmit to BCBS instead of waiting the full 12 months. I decided
not to wait and submitted what I mid March and was approved the end of
April. I did not think I had enough documentation to meet the requirements,
but I was approved. I mention all of this because, I was told that my
employer may have a rider in their policy that supports WLS 100%, but their
are other companies out there that exclude it. I read your profile and see
that you have been considering WLS since July 2003. I hope that you have
started a supervised diet and if not please do so immediately. It may be
harder than you think to get approved, and then again it may not be hard at
all. No one can say for sure.
Hope this helps,
Lap RNY 06/03/04
— ToriJ
May 7, 2004
Sharee, please post a link to the information regarding BX not covering WLS
anymore. Having been in the insurance industry for over 5 years it really
angers me when people make blanket statements like this. If BX as a whole
is no longer covering WLS please provide documentation. I'm sure we would
all like to see it so that we may slam numerous emails/letters/phone calls
to them to rally support for all of us on this journey. Rebecca Perkins
10/03/01
— RebeccaP
May 7, 2004
Hi Rebecca. The one that I know for sure has announced they are dropping
coverage as of next year is BC/BS of Florida.
— Jim F
May 7, 2004
Wonderful, Jim. Please show me this. I live in florida so that's even
better. I would love to pester the hell out of them for this fact. BX is
somewhat like a franchise...each segment can make their own rules. If BX
of Florida is trying to do this, then I would like to get the email
address, mailing address, and phone number for the CEO so that we all may
contact him. I think he needs to hear from us. Rebecca
— RebeccaP
May 8, 2004
http://www.bcbsfl.com//ocyh_our_company/currentDetails.cfm?ID=20040213163654&Method=Full&Cache=Off
Is the link where BX of florida states it will be removing WLS as a
benefit from SOME of thier products. Not all of them. The Chairman and
CEO of BCBS of FL is Michael Cascone Jr and can be reached at PO Box 1798
Jacksonville FL 32231-0014. Mark S. Wright is the contact on the document
itself and can be reached at 904-905-6935. I will be sending a letter to
the CEO asking for an email address. Once I receive that information I
will post it frequently here on these boards so that we may all just click
a button to let them know how we feel. If you should feel the need to
contact by snail mail....yea for you.
— RebeccaP
May 8, 2004
Here's a recent CNN articale that mentions it:
http://www.cnn.com/2004/HEALTH/03/03/gastric.bypass.ap/
— mom2jtx3
May 8, 2004
Rebecca, I also have seen news articles indicating that BCBS of Florida
will no longer cover WLS in any of their standard policies. Obviously each
employer can choose to buy a custom policy and have it covered. I have
also seen where numerous people are having problems with BCBS of Illinois
not covering without a long supervised diet etc. That just started with
2004. I have not seen any of these two things being applied to any other
BCBS policies throughout the country. Either they are keeping it very
quiet or it's just two factions of BCBS that are going in this direction.
I am 99.9% confident that the BCBS policy I have, which is developed by the
State of WI for it's employees, will always cover WLS. It is the most
expensive policy but has no limitations where you go etc. I do not know if
their requirements have changed but I had no trouble getting approval.
<p>If you are confident you meet the qualifications, and can find a
surgeon who will get you in before the end of the year and are 100% sure
they cover WLS then I would get added ASAP. You should be able to
determine if it is a covered benefit by looking in your fiance's benefits
booklet under the exclusions section. There will be a statement in there
about treatment for weight loss. Usually it says nothing is covered unless
you are morbidly obese and have associated disease etiology. If that
exception is in there then the next thing is for you or your future hubby
to call and find out what the qualifications are to be approved for WLS and
what docs are covered. You have a bunch of legwork to do on your end but
it just may work out.
— zoedogcbr
Click Here to Return