Help w/ BCBSNC Blue Options

PBANKS
on 10/22/18 8:57 am

I know this is going to sound odd and you're going to be like "why doesn't she just wait 3 more months", but I don't want to wait any longer. I currently have UHC and have had UHC for 19 years. My employer is changing insurance in Jan 2019 to BCBSNC Blue Options Plan. UHC doesn't cover bariatric surgery unless medically necessary, so does anyone have BCBSNC Blur Options plan? If so, does it cover bariatric surgery? Do you know what the length of medically supervised diet time frame is? Thoughts on BCBSNC service for bariatric surgery? Are they difficult? Thanks for any help

Thanks,

Getting Started

Kathy S.
on 10/22/18 10:22 am - InTheBurbs, XX
RNY on 08/29/04 with

I don't have this plan but may I suggest you contact them and find out all the particulars. That way you will be sure of what is available at the time when you take over that insurance. Things change so quickly.

Good Luck!

HW:330 - GW:150 - MW:118-125

RW:190 - CW:130

PBANKS
on 11/8/18 7:27 am

Thank you.

The representative from BCBCNC said the surgery is not covered, but when I pressed him about it being deemed medically necessary he did not have an answer for that...also, my HR department is being no help.

Liz WantsHealthForAll
on 10/22/18 11:12 am - Cape Cod, MA
VSG on 03/28/16

Most of the time, the employer has an option to include or exclude Bariatric surgery, so you will need to call to find out if your employer has chosen to cover it in your new plan. I had a change in health Insurance from BCBS to UHC just after I started my WL journey. My employer had chosen to include it under both but the terms were different. It was a challenge to get the details for the new plan prior to it becoming effective, but after explaining the situation they did provide the information (centers covered and requirements).

Liz 5'3" HW: 219 (BMI 38.8) SW: 185 GW: 125 CW: 115-118 (BMI 20.4-20.9) - TT and facelift 1/11/2017 - Brow and eyelid PS 12/11/2017.

WL: Pre-op: -34 M1: -17 M2: -12 M3: -11 M4: -7 M5: -7 M6: -5.5 M7: -3.3 M8: -3.3 M9: -2.5 UNDER GOAL since 10/12/2016 - in current range since 12/10/2016. Average maintenance calories 1350

Sparklekitty, Hag of Science
on 10/22/18 11:44 am
VSG on 12/10/13

Every employer's plan is different. Even if someone else has Blue Options, they may not have the same requirements that you do.

I would suggest reaching out to your HR department to see if you can get specifics, such as the benefit book that will take effect in January. Or see if they can connect you with customer service for the new plan, and they can give you detailed information on the coverage for bariatric surgery.

For what it's worth, most insurance plans don't cover bariatric surgery unless it is "medically necessary." Necessity is often defined with a combination of factors like BMI, comorbidities, weight/medical history, and the like.

Nerdy Little Secret (#42) - Tucson Roller Derby

PCBR
on 10/22/18 8:30 pm

Exactly!

Before you swap plans, are you certain what is meant by medical necessity?

HW: 260 - SW: 250

GW (Surgeon): 170 - GW (Me): 150

PBANKS
on 11/8/18 7:31 am

Thank you.

The representative from BCBCNC said the surgery is not covered, but when I pressed him about it being deemed medically necessary by my PCP he did not have an answer for that...also, my HR department is being no help. I've called BCBSNC directly and without my actually policy number they cannot give me any details.

I've completed my first "12 month medically supervised diet" through my PCP and plan to have #2 on record by the insurance effective date 01/01/19 so at least I'm not wasting time.

Julia S.
on 10/24/18 1:45 pm
RNY on 02/12/18

I have UHC and the requirements on my plan were that you needed to show you were at least 100lbs overweight for 5 years, they didn't have to be consecutive but just documented by your doctor. There was also a 6 month physician supervised diet, there was no set amount of weight you were required to lose. Just show that you met with in my case the surgeon or the WLS office for 6 months. The surgeon also has to be Center of Excellence certified which is only for UHC and it is difficult to obtain, even if their practice has the certification the surgeon also has to be certified and it is some ridiculous amount of surgeries like 2000 that they have to perform and jump through a bunch of other hoops.

Whatever program you chose they also have specific requirements you have to fulfill before they will allow you to have surgery.

Good luck on your journey, don't give up!

5'5" 60 years old HW 291 SW 275.8 CW 190

M1-18.8 M2-6.5 M3-11.2 M4-8.5 M5-9.4 M6-3.2 M7- 7.7 M8-11.2 M9- 6.4 M10-In progress

Valerie G.
on 10/26/18 11:12 am - Northwest Mountains, GA

I got my DS with UHC. I had to be 100lbs overweight and have the support of my PCP by way of a letter of my necessity. That was it.

The thing with insurance is that the plans differ by what the employer pieces together. BCBSNC may be completely different with another company. Bariatric surgery, for instance can be completely excluded as a covered benefit, necessity or not. Companies choose this in exchange for lower premiums.

Valerie
11 years post op DS 
There is room on this earth for all of God's creatures..next to the mashed potatoes

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