Survey about BC/BS HMO Please

Can you please post if you have BC/BSFL (Health Options)HMO, I would like to know the hurdles you have had to go through with your approvals / denials and who you spoke with @ BC/BSFL to assist you (name ext. #, etc) so if I am faced with hurdles I might have some success in cutting through the red tape. Do any of you mind doing this survey? Thank you, Marilyn

I have this company. I had no problems at all. I was 311 pounds at start with a herniated disc. No other co-morbidities other than border line diabetic. I have been with the same pcp for the past 20 years. I have been more than 100 pounds overweight for the past 15 years. I have numerous supervised diets with my pcp physician as well as documentation from him showing I took all sorts of diet pills (phen-phen, phentermine, meridia etc) My surgeon submitted my paperwork and I was approved in 2 days. I called BCBS and spoke to the cust service dept. I wrote their name down, the name of the medical director who approved the surgery and they gave me a confirmation number of the phone call. My surgery was 5/10/04. I hope you have it as easy as I did. Good luck

Interesting. I have Health Options of Fla as well. When I asked about coverage a year ago they said it was on a case by case bases. About three months ago we all received a letter from BCBS which basicly said a new rider was being put in effect to out policy (I work for a county Government) and that WLS was not not covered under any conditions. The "official" reason given was that WLS was becomeing more and more common and in there opion was being performed to often fon people who should not have it (in there opion of course). I applied a three months ago and got rejected out of hand, the rejection letter states as the reason to see the rider to my policy discounting WLS. I appealed but was shot down right away as well, I was old by someone oveer the phone with BCBS thatthe company was "cracking down" on procedures that they feltthey were being taken advangage on by hospitals and some doctors. (A bunch of BS as far as Im concerned, I think it was starting to hit there bottom line a bit to much). I was lucky in that I was able to arrange financeing through a relative. Keep in mind I most certinly quilify, as Im 418 pounds, 6'-3", Diabetic, High Blood presure, Sleep Apnea, and have High Colestoral. I dont know if the different Blue Cross companies have different rules they follow or if they alll follow rules dictated by Corporate, or what.

I dont have the link anymore, but a search in Google useing the keywords "Health Options, Florida, Weight Loss, WLS", SHOULD, bring up the offical press release from BCBS of fla that they released when they officialy started banning coverage for WLS.

I have BC/BS Health Options and was approved for a consult with a surgeon. I haven't had the consult yet. I think coverage may vary even within Health Options, depending on your policy/employer or whatever. The letter I received said they would not cover the surgery after Dec 31, 2004. When I called the company, the customer service person said that if you were in the process of qualifying for the surgery this year, but don't have the surgery until 2005, Health Options would still pay. I'm not holding my breath, though.

I was told that under my BC/BS PPO plan, that surgery was covered "if deemed medically necessary" through 12/31/04, but you had to have surgery by that date - no exceptions. So, if you have approval, but not the surgery they weren't going to pay. Who knows for sure, anytime you call BC/BS you get a different answer, etc. Best to find out who handles your company's plan within BC/BS and deal directly with them. The 800# call in line, all seem to read from a script. I was told that WLS wasn't covered, when I knew it was. As I talked to the person at the 800# and told them to research "my plan" they said well it is covered but.. blah, blah, blah. BC/BS is all about their premiums, not about their policy holders! I am amazed that with Gov. Bush big push on obesity in FL and what an epedemic it has become, that the insurance commission or some other agency isn't on BC/BS case for excluding WLS coverage in their plan. Its all about the $$$.