Question:
I ran into two friends who work for BCBS.

Tonight I ran into a couple who work for BCBS. We were discussing WLS and they said insurance would no longer pay for any weight loss surgery after this year. They said this was based on the fact that people were no longer trying to lose on their own and that doctors were doing it on people who wern't big enough. Also that people were actually gaining in order to have surgery. I am afraid the last part is true. Anyway is this true? Has anyone else heard this?    — Tawnda C. (posted on January 30, 2004)

January 30, 2004
I think everyone's insurance is different. Your best bet is to call yourself and find out what your own policy will and will not cover. I have BC\BS out of California and they will cover the surgery my only issue is that I have to fight for the one I want because they will cover the rny but not the ds.
   — davesband1

January 30, 2004
I am in the health care field (Nurse Practitioner). I do not know for a fact, but I can see certain trends in health care. I would bet the farm, that the standards are going to change soon. I believe that they are going to insist on real co-morbidities. I am glad I am getting mine now, while the gettin's good. Keri 2-10-04
   — Kerijohnson

January 31, 2004
I work in health care and insurance (nurse in medical management) and our plan has not changed even though more members are getting WLS. In fact, the criteria was changed to make it even easier to have surgery! We have a Medical Director who realizes that obesity can cost more to the plan in the long run than the cost of the surgery. He has a lot of clout when it comes to what the plan covers. Unfortunately, most companies are run by financial sorts who only see the bottom line at one time. In other words, they don't add up what the costs are for medical care for a person with a lifetime of obesity, as opposed to the cost of surgery to treat obesity. It also took a long, long time for alcoholism to be recognized as a disease, and obesity is a disease, but trying to change the idea that is is a weakness of character is still a long way off. By the way, WHO is this "they" that is saying people aren't trying on their own to lose weight before considering surgery, and that they "aren't big enough"? Insurance companies have criteria that has to be met to approve surgery, generally based on NIH standards. I really think it comes down to $$$ with insurance companies. Look at it this way, too - many insurance plans have dropped coverage of infertility treatment. (After all, it really isn't "medicaly necessary" to have a baby. Don't flame me here - just telling you what is going on - and our particular plan still has that benefit.) Personally, because there is so much more in the media today about the sucesses of people who have had weight loss surgery, the pressure may be on insurance companies to cover it. However, most insurance companies sort of "customize" plans for their insured, so if a corporate exec sees fit to save money by adding an exclusion for weight loss surgery to the plan they purchase for their employees, there is nothing that can be done. (Once again it's someone looking purely at $$$ making the decisons.) So, don't get mad at insurance companies - get mad at the people who purchase the plans that exclude WLS! How many times have you seen it on this board that two people can have the same "brand" of insurance, but one person's plan covers WLS, and the other's has an exclusion?
   — koogy

January 31, 2004
I work in the telecom business (DSL tech) ... okay so that doesn't apply here ;)~ Anyway, IMHO I am certain they are going to get tighter with the approval process. I did have a male friend who was about 10 pounds short of qualifing and he said he was going to gain that weight so he could have WLS but that was about 2 years ago and he hasn't done any more to get the surgery. Also I heard from one of my support group partners that she read that WLS is the #1 for of weight loss to be used in the year 2004. I guess time will tell, I am glad I am done with my surgery and happy to be down 42 pounds in 7 weeks!!
   — Angie Taylor

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