BCBS FL State Employees PPO Policy help?

Hi, Does anyone have information about State Employees PPO approving laparoscopy gastric bypass. BCBS of Fl is tellling me that I am approved but they do not approve laparoscopy only open method. Do you know if anyone has had it under this policy? Sharon

Hi Sharon I am a State Employee and got approved last December for the Lap WLS that I had last March 2nd. Last I knew being several of my co-workers have had this surgery, {lap} latest being this past July they still approved for Lap as well as open. Sounds like you need to speak to someone else for some further clarification.. Good Luck! Becky -112

Sharon- If no one answers your post then you might try looking through the information on the insurers page. Just click on "insurers" at the top of this page then click on Florida-then on the B's. There will be a lot to scroll thru but you might find the information for which you are looking on that list. Just be sure to check the dates. Some of the information is several years old. Red

I'm a state employee and have BCBS, but not sure of the PPO. Don't remember which plan it is. Anyway, mine was done lap in May of 2004.

I work for the state but have AvMed. I heard BCBS changed their policy at the beginning of this year. Call several times and speak with different people. It's amazing how the story changes depending on who you are talking to... or you could ask to speak with a supervisor at BCBS. Or you could change your policy... it's coming time for open enrollment... I KNOW AvMed covers lap rny. Erika

Hi Ericka, I work for the state also and have AVMED, when I called I was told AVMED does not cover wls. I was told AVMED will reimburse you for payment made to Weigh****cher if you reach your goal. Since, we are in open enrollment I'm looking to switching insurance company.

AvMed covered mine at 100% (with a 250.00 co-pay). They approved mine the day they received the letter of medical necessity from my docter. I had my surgery on 8/9/05, and had no problems covering it.. I have sleep apnea as my only co-morbidity. I know they also do the weigh****chers thing, but i never even attempted that... my bmi was 47. I wonder if they have different plans for different dept? I work for the Dept of Health???? Good luck!!!

I was looking at AVMED benefits today, it exclusion stated no weight loss surgery unless it medically needed. Because, I was told it was not covered by one of their customer service rep. I did not attempted to get approval from them. Instead, I'm going through Vocational Rehab. I think I will call Dr. Jawad's office tomorrow and ask them to submit my paperwork to AVMED. The way I see it. I have nothing to lose by asking and everything to gain. I'm employed by the Dept. of Corrections. and has been diagnosis with high blood pressure and sleep apnea with a BMI of 45. Thanks for the info!

Hi Monette, I see where you have nothing to lose there. I am alos a DOC employee. I took no chances with mine cause at the time that was all the talk that WLS was being excluded. Well I have BCBS of Fl PPO though but still we were all freaked. Leave no stone unturned. I will tell you---I went to my PCP, Gyno, bone doc and Nutrionist for letters and all the paper work from when I first seen them including weigh-ins and such. "Medical Nessecary" is a term that can be loop hoiled through if you don't send them everything backing up your story.My PCP, Gyno and Nutrionist wrote me letters also. Good Luck my friend. Becky

Hi Bulldog Lady, I'm at the point where it not if I'll have this surgery but when! I called Vocational Rehabilitation to talked to my case manager to see if my completed package has been forward to Tallahassee, FL for approval but she was out of the office on Friday. That will be one of the first thing I'll do on Monday, then I will called my PCP for a letter of medical necessity to be included in my package for AVMED, which should not be a problem at all because she was the one that suggested I have the sleep studies to further justified my need for the wls. If plan A and B fails, on to Plan C which is my spouse is also a state employee and retired Navy which quailified us to get insurance coverage through Tricare which I know will cover the wls. So, if I don't have an answer by Oct. 28, I will switch my insurance to Tricare. If I have learned anything from the site, it has been to be determined and assertive because it about better health and quality of life which everyone has a right to have. I truly appreciate your insight and will take your advice to let no stone be unturned. Thanks! Monette