What does BCBS require for WLS?
I read this in a Alabama newspaper online this morning and I pasted some information.
Blue Cross tightened guidelines Nov. 30 for weight-loss surgery, requiring patients to prove through medical records at least a three-year history of serious obesity and a doctor-monitored weight-loss program in the six months before surgery.
The Blue Cross guidelines say the weight-loss programs are meant to decrease surgical risks and to test whether the patient will be able to follow the serious dietary restrictions after stomach stapling.
"The motivation with all of the guidelines is to be sure that patients are proper candidates for this procedure because it is a life-threatening procedure and it is a life-altering procedure," said Jim Brown, Blue Cross' spokesman.
Patients normally have to be at least 100 pounds overweight to qualify for the surgery. Requiring three years of records showing a patient's weight and height is meant to weed out patients who intentionally gain weight to qualify.
If the insurer had wanted to cut costs, Brown said, it could have chosen to quit covering the surgery. Already in Alabama, UnitedHealthcare, VIVA Health and HealthSpring of Alabama don't pay for bariatric surgery except under policies they administer for self-insured employers that choose to cover it.
I hope this is helpful to those who are dealing with BCBS.
Tammie G. now a loser and is insured by BCBS of Georgia
I am not really sure what they require now. Before my surgery they wanted 6 months of doctor structured weight loss programs and all the tests that your pcp and the weight loss doc wanted. Plus they said it had to be life threatening. I know this probably won't help, but wanted to let you know that you are in my thoughts and prayers on your journey.
Hugs,
Debra =^..^=