BCBS STATE OF FLORDIA PPO Informaiton

News that makes me feel good. I spoke with BCBS of Florida State PPO this morning. The lady was extremely friendly and helpful. She even told me about a friend’s success with the surgery.  So here is the answer to my own questions for anyone else in need. This insurance plan will cover the surgery if it is medically necessary.  We all know that the definition of Medically Necessary is BMI > 40 or BMI> 35 with diabetes, cholesterol, sleep apnea and blood pressure problems. They will cover 80% after the 250 calendar year deductible.  The hoops: Need a Psych evaluation, GP must write a letter explaining the medical necessity including possibilities of stroke, 6 months of supervised diet and no weight gain related to thyroid problems. BCBS also requires a history of weight problems 5 years or more. I have been overweight since I was 11 or 12. So I don’t think the history will be a problem though I have only been seeing my current physician for about 6 months. She is or has been very receptive to all we have discussed to this point about medical treatment so hopefully that won’t change.

Brad, I have BCBS of Florida PPO state employee plan and I just had my bypass surgery on July 2nd.  My co-pay for the hospital was $2k and the doctor was $400.  They paid everything else and I was approved in one week from submitting my paperwork.  My 6 month of diet with a doctor was 3 years ago and they used that and everything was ok.  Good luck.  Sandy Wesley

That is good news. I get more and more excited about this every day. I look forward to getting my sleep study and seeing my GP to get a referal to the surgeon.  Can you tell me anything about what the psych exam required is?

Brad go to ecery Doctor you've seen inthe last SIX Years and have them fax your Complete Medical Records to your Surgeons office. Good Luck.

I already tried that. The doctor I was seeing previously was for 6 and a half years. He kept no records. I went and picked up the records as well as had a set sent to my new doctor for comparison. There was nothign in there about the weight loss issues, diabetes, or any of the weight loss drugs he had me on over the years. He simply did not keep the records or isn't turning them over to me or my doctor. I changed doctors to finally be treated for diabetes. Amazing always had moderately high blood sugar until meds and now it is always right at 100.  So I am nto sure what I will do abotu the records. I may have to go through the 6 months diet.  Will wait and see after my sleep study when I see my new GP again.

Welome!   We have this insurance and last year (April 2006) the lapband was not covered since it was considered investigational .. Ask for the fine print - what page in the booklet states that this lap-band procedure is covered.  I got many runarounds and most of the time the person thought I was asking for gastric bypass rny - they didn't know what a lapband was - but things may have changed I sure hope so!    Good luck to you - I am off my blood pressure & cholesterol meds and loving life! 

Do you have the state empoyees PPO? I find it odd though I know insurance companies are odd. I Read the manual including all exclusions and called and spoke to someone as stated above. They say no problem as long as it is deemed medically necessary which it will be based on weight and comorbities.  Brad

oh I forgot it does nto specifically address any type of surgery. In the 2007 plan booklet for state employees ppo under the exclisions you see the following 

Weight reduction services including all services, supplies, and prescription drugs related to obesity except:

1. medically necessary intestinal or stomach by-pass surgery, or

2. medically related services, excluding prescription drugs, provided as part of a weight loss program when weight loss is required by the covered person’s surgeon before performing a medically necessary covered surgical procedure. Coverage for these services is limited to $150 per person in any 12-month period. I was very specific in addressign the lap band but will call back monday and ask again to be sure.

Still looking to hear from someoen with the same insurance and news of coverage.  Anyone?

I have the same insurance and had gastic bypass 10/11/2006 I was responsible for 2K and BC/BS took care of the rest. I called BC/BS and gave them the exact billing code to be used by my surgeon.  They put in in the computer and told me they would accept it as long as the requirements were met. They required a BMI over 40 and some other things. I think its all listed on my profile/blog thingy on here still. I am sure you will be fine  Margo Marie