BC/BS to begin coverage of WLS

I went to my monthly support group meeting today and heard some very exciting news. According to our program coordinator, the national president of Blue Cross/Blue Shield is to issue a memo that WLS will be a covered benefit but only if the hospital and surgeon have been certified as a "center of excellence" which means they have taken certain steps to prove that doctors and hospital staff are very well qualified. As you all probably know as of 1/1/05 BC/BC of Florida decided to exclude everyone from any type of WLS. There was no mention of a time frame....but if you have BC/BS don't give up hope. Maybe in another 6 month to 12 months thing will begin to turn around. And if BC/BS does this the other large insurance companies are bound to follow. We can only hope!

My surgeon and his office are working hard on their Centers of Excellence certification. I know that a large part of this has to do with follow up care and Dr. Jawad's team is so good with this. They have a support group and a terrific message board and ongoing communication with all the members of the team (medical, nutrition, exercise, psychological, etc.). This news from BCBS is a very happy, welcome announcement! Jan 240/131/115

This is really great news. I think we will benefit from this "center of excellence" requirement as will all those who are awaiting approval that have BCBS. I hope other insurance carriers will follow suit. luvitsunnyv

Hi Janice, I just wanted to say it was very nice meeting you in person Saturday at the support group meeting...and I want to also tell you that you did a great job setting up and seperating all those clothes for the clothes exchange...if I can ever help you out please let me know and I will be looking forward to seeing you again at another meeting...have a wonderful Sunday... April

Thanks April! I may take you up on your offer in a few months, once you're on the losing side and well recovered. Hope you get some good news like oh let's see..... YOUR APPORVED!!! Keep us posted!

Yes, I did hear the same thing. Our support leader told a pre-op in the group to continue to get documentation on the 6 month supervised diet, etc all the requirements necessary So that when the approval comes from the insurance company(ies) she will have all her "ducks in a row" and the approval process will be quicker since she has already pre-done all that is required. So any pre-op reading these posts..if you haven't started with documentating the requirements start doing it so that you can get approved as soon as the insurance companies give their go ahead. Good luck to ALL.

Wow Janice that is great news! Hope all is well with you.

Yes, I'm doing great. How about you? Aren't you planning PS soon. Which doc did you decide to go with? Which procedure are you getting first, second...etc. What about the cost. I'm still 8 months to 1 year before I'll be ready but I've started saving. How's Charlie? I haven't seen any post from her lately.

I believe the Centers of Excellence status to which you are referring is actually a designation awarded by Surgical Review Corporation (SRC) which is a non-profit corporation formed I think as an offshoot of the American Society for Bariatric Surgery. You can get more information on the criteria for the designation and the process at the SRC website. http://www.surgicalreview.org/ Red

Hey Red--yes you are right about that. It is interesting that an insurer would use this designation--but I guess that the whole concept was to weed out the bad docs which are giving wls a bad rep.