Does BCBS cover the sleeve?

cthr
on 7/22/12 8:10 pm
 Has anyone had the sleeve coverd by BCBS?
Kevin H.
on 7/22/12 9:02 pm - Baltimore, MD
VSG on 02/06/12
It's different from State to State .. call them and find out.  That's the only way you will know for sure and what is required by them to qualify for it.

 
  

morgans
on 7/22/12 9:03 pm
VSG on 06/18/12
 My BCBS of Illinois covered it, but the coverage may be specific to not only the overall provider but to the specific plan I'm enrolled in (a very good one).


       
Jewelz13
on 7/22/12 10:01 pm - TX
CHECK YOUR EXPLANATION OF BENEFITS PACKET UNDER BARIATRIC SERVICES.  YOU CAN ALSO ACCESS YOUR EOB ON-LINE ON YOUR INSURANCE WEBSITE.  IF IT STATES PRE-AUTHORIZATION REQUIRED, THEN CHANCES ARE IT IS.  THERE WILL BE SOME REQUIREMENTS YOUR INSURANCE MAY HAVE YOU DO BEFORE SUBMITTING FOR AUTHORIZATION.  TIME IS OF THE ESSENCE BECAUSE MOST INSURANCES REQUIRE A MEDICALLY SUPERVISED WEIGHT LOSS PROGRAM WHICH COULD BE AS SHORT AS 1 MONTH AND AS LONG AS A YEAR.  SO IF YOUR CONSIDERING THE SLEEVE YOU MAY WANT TO START THIS WITH YOUR PCP.  YOU CAN SEARCH BARIATRIC REQUIREMENTS FOR PRE-AUTHORIZATION ON THE SITE TOO.  MY REQUIREMENTS WERE AS FOLLOWS:

-BMI OVER 40 WITHOUT COMMORBIDITIES OR 35-39.9 WITH AT LEAST ONE
-6 MONTH MEDICAL SUPERVISED WEIGHT LOSS PROGRAM (COVERED $45 COPAY/EA.)
-PSYCHIATRIC EVALUATION($45 COPAY)
-TWO YEARS OF MEDICAL DOCUMENTATION SHOWING BMI OVER 40(FREE UNLESS THEY CHARGE)
-NUTRITIONAL CONSULTATION (NOT COVERED $300)
-CONSULTATION WITH BARIATRIC SURGEON SHOWING MEDICAL NECESSITY($45 COPAY)
-MEDICAL CLEARANCE FROM PCP FOR SURGERY

ADDITIONAL CHARGES

$500 ANNUAL MEDICAL DEDUCTIBLE
$5000 ANNUAL OUT-OF-POCKET
PROTEIN SHAKES (NUT SAYS IT WILL COST ME AROUND $100/MONTH)
VITAMINS(VARIES)
 
HOPE THIS HELPS!  LET ME KNOW IF THERE IS ANYTHING ELSE I CAN HELP YOU WITH
                
Mom4Jazz
on 7/22/12 10:02 pm

Tough question. As the other commenter's said, there are a number of different independent BCBS providers and some coverage details are specified by your employer's plan.

That said, my BCBS did pay for my sleeve. If your policy covers weight loss surgery, most of the BCBS that I'm aware of now cover the sleeve. It's more a matter of whether they cover weight loss surgery at all.

Highest weight: 335 lbs, BMI 50.9
Pre-op weight: 319 lbs, BMI 48.5
Current range: 140-144, BMI 21.3 - 22

175+ lbs lost, maintaining since February 2012

MuttLover
on 7/22/12 10:13 pm
VSG on 11/14/12
All BCBS (or any other insurer) is not the same.  If you work for a large employer group, they are typically "self-insured", which means that they can write some types of coverage in or out.  The only way to know for sure is to call your plan and find out. 
char_in_md1
on 7/22/12 10:24 pm
carefirst bcbs of maryland covered it but I had to appeal it one time, they originally denied it...
sutherngrl94
on 7/22/12 10:40 pm - Raleigh, NC

BCBS of NC covered mine.  I'm in Raleigh, NC.  The best solution is to call your insurance company to find out.  I was in contact with mine before I even went to the the first meeting with Duke so I knew what to expect and even after that I called again to make sure I was told the same information.

            
  
diane S.
on 7/23/12 12:01 am
BC cal covered mine but only after appeal. they have since changed their policy. so read your plan. it varies from state to state and plan to plan. diane

      
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Bf516
on 7/23/12 12:17 am
BCBS, differs from state to state & from plan to plan

I can say my BCBS Anthem does & it was a fast response from them.

Good luck
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