FYI: BC/BS

Hi everyone! I just wanted to make sure people know that as of 01/01/04, Blue Cross/Blue Shield ARE including an exclusion policy for WLS! So if you are dealing with them, pu**** through as fast as you can, OK? Happy Holidays to you and yours! Blessed Be! Sherry

What the F*@# !!! Is that for all BC/BS ? I have BC/ BS of IL PPO...They told me back in September to do a a six month supervised diet and resubmit !!! That why I was denied... Im so pissed .....Please let me know...Just email me would you Please !!! Thanks, Stacy.......... XOXO

Hi Stacy! Per my new surgeon's office, Dr. Bruce Hardy, M.D., located in Ames, IA.,: BC/BS writing an exclusion to all WLS, effective 01/01/04. From what I understand, that is company-wide, not just state-by-state. (Iowa is Wellmark BC/BS of Iowa.) I'm not sure how it works if you are in the process of trying to overturn a denial, but I would call your surgeon's office and BC/BS right away! I hope that for your sake, and for many others, that once you are in the process, they will be committed to pay. I truly wish you good luck, Stacy! Blessed Be! Sherry

A very reliable source (someone who works at Wellmark BC/BS) told me today that they have NOT excluded WLS from their plans. To see the guidelines on their website for "surgery for morbid obesity" (which is not changing 1/1/04), go to: http://www.wellmark.com/e%5Fbusiness/provider/medical%5Fpolicies/policies/obesity%5Fsurgery.htm If you have GROUP coverage....meaning your health insurance is through your employer....your EMPLOYER can decide to stop covering WLS. Some employers have decided to do that effective 1/1/04. If your employer is no longer covering it, then you should talk to your HR department or the head of your company. They ultimately make decisions about what provisions are in your health insurance plan. I called last week to Wellmark to see if my employer made any changes to the plan regarding WLS, and they did not....but the guy I spoke to also told me some employers are excluding it. When I went through infertility treatment, I got lucky -- I had coverage. (costs $10,000 just for one round of in vitro fertilization) But within 2 yrs, my employer made IVF treatment an exclusion. Many other employers have followed suit. The reason? Higher claim costs drive higher premiums for coverage, and employers and employees are already upset about how much it costs for coverage. Sometimes employers "tweak" their plans, changing things that cost a lot and benefit only a few people. Like infertility treatment, I'm sure WLS is starting to fall in that category. Also, BC/BS plans are all independent. So what the Iowa plan does may be different than what the Illinois plan does, for example. I don't know if this info is true for their HMO plan in Iowa. Just wanted to clarify more on the issue because I know many of us have coverage through their Alliance Select plan. Francie (hoping to have WLS in January at Mercy in DSM)

Thanks for the information on the BC/BS website. AS of 01/01/04 my insurance plan will change but still be with BC/BS. I have been approved for WLS until April of 2004 but may have to apply again due to program change within the company. My HR department and the doctor's office did not see any problem. Called Mercy yesterday and was told I would be having my surgery in January, just waiting for the date. Good luck Francie on your January date. Bob Happy Holidays