Question:
BCBS making national changes to cover wls. Someone posted BCBS would be making
changes nationwide in 2003 so that all their ins. companies would be required to cover wls if medically necessary. If this is so, could someone please email me further info. or where I might get the info. I tried the BCBS website, but NOTHING> There are several people I know with BCBS of MS that would love & need to have surgery, but BCBS has an exclusion that you can't get around. I had to pick up a 2nd full time job to get ins. to cover mine & not everyone can do this. Please email me any info you may have. Thanks!!! — Belinda W. (posted on October 25, 2002)
October 24, 2002
I don't know if this is true or not but my company just signed up with BCBS
of Florida and there is a NEW exclusion they just started, they will not be
covering the surgery according to my new book. They will also not be
covering any complications arising from previous weight loss surgeries.
This is an adendum to the origional book. They used to cover both. Not
anymore. Very disappointing, really. My former insurance didn't cover
anything for my surgery and I was looking forward to having one that would.
When will these companies learn that this is a life saving procedure? What
is wrong with these people, anyway?
— KelBurt
October 24, 2002
I'm not about the answer to the orginal question. I have comment about
Kelli's response. The kicker to all this Kelli is it could be that your
company had chosen not to cover it. Each company selects the type of
coverage they want to offer through an insurance policy. If your company
wanted WLS covered it would be a part of your policy.
— Cheryl S.
October 24, 2002
I have the great news!! It was me that posted about the "standardized
national plan"!! My company has BC/BS of California, and we are doing
open enrollment right now. When we got the new policy and limitations
booklet, I jumped ahead to the obesity clause. This is how it
reads..."Obesity Exclusion and Limitations: Services primarily for
weight reductions or the treatment of obesity. This exclusion does not
apply to surgical treatment of morbid obesity as determined by us if we
authorize the treatment in advance as medically necessary and
appropriate." Now, that in layman's terms, means that they WILL pay
for it as long as you jump through all the hoops to deem yourself in
medical need!! YEAH!! At the very beginning of the booklet it has the
statement about the "standardized national plan" under the
heading "Changes effective January 1, 2003." Hope this helps you
out!! :*)
— Ann H.
October 25, 2002
There is no "national" BC/BS. From their web site
(http://www.bcbs.com): "We are the Blue Cross and Blue Shield
Association, the trade association for the independent, locally operated
Blue Cross and Blue Shield Plans."..."The 43 local member
companies of the Blue Cross and Blue Shield Association have provided
millions of families like yours with top-quality, affordable health
insurance for more than 70 years."
<p>
As the web site says, the 43 local BC/BS plans are independent and locally
operated. That means that there is *no* national standardized plan. Each
individual BC/BS makes their own decisions regarding coverage of WLS (or
any other procedure) and even that isn't the definitive word. If an
employer has BC/BS, but if it's self-funded (the employer pays out the
claims - all BC/BS does is the administrative work), the employer can
exclude any procedures that they want to.
— John Rushton
October 25, 2002
John is right.
— RebeccaP
October 25, 2002
I had Lap RNY in June of this year and mine was covered through BCBS of
Minnesota. They were wonderful, approval within 5 days, no hassles what so
ever. I bet the exclusion is through your employer and that is something
you will need to take up with them, it is hard to get them to change an
exclusion but not impossible.
Good Luck!
— Cassy H.
October 26, 2002
As someone else stated, There is no national BCBS coverage...they are all
independent of each other. BCBS of Florida will no longer cover the
surgery as of 2003. As groups renew the WLS will no longer be covered. My
group renews in January and the coverage for WLS ends in April, because my
group would have already renewed, it will be covered until the next renew,
January 2004. More and More Insurance companies are excluding coverage for
this surgery. I feel it is a VERY BAD decision on their parts !! I like
so many others, feel that, NO, KNOW THAT THIS SURGERY SAVED MY LIFE.
— Sharon H.
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