insurance issues
I am just about to have the Bariatric program at HCMC submit to my insurance. So yesterday I called my insurance company (Benefit Plan Administrators, 3rd party for Medica Select Care) and the customer service SUPERVISOR didn't know the WLS requirements! I couldn't believe it. So I have no idea if they even cover WLS at this point. We'll see what happens when they get the pre-auth from HCMC but now I'm not counting on anything. Very frustrating!!!
Ok so im not 100% sure but here is what im thinking. Blue Cross has a 3rd party admin called CCS and they go by the same medical policy as blue cross. So if your insurance is like that they would go by Medica's medical policy. Here are some links i found on their website but the easiest thing to do is go to medica.com click on search and type in bariatric surgery. If y our group is self insured check with your human resources to see if they allow the surgery. Ok thats kind of confusing so if you have any questions just ask :)
http://provider.medica.com/router/default.pdf?doc=/C10/PolicyUtilization/Document%20Library/IIISUR30.pdf
http://provider.medica.com/C5/CentersOfExcellence
http://provider.medica.com/router/default.pdf?doc=/C10/PolicyUtilization/Document%20Library/IIISUR30.pdf
http://provider.medica.com/C5/CentersOfExcellence
Thanks for the suggestions but I already asked my 3rd party admin if they go by Medica's policy and the Cust. Service person said they don't, which confused me even more. I also asked my HR person but all she said was someone in our office had WLS about 2 years ago and she thought it was covered. I just can't believe nobody can tell me what the requirements are and if so, if it's even covered!