Kaiser Permanente or Carefirst BCBS PPO?

Open season for choosing my insurance is coming very soon.  I have been lurcking here at OH for a year and have finally decided it is time to go on with getting WLS.   I would like to have the WLS later this year (RNY).  I discussed with with my doctor about 7 months ago and she agrees... I need the surgery. Do any of you all have any thing to say about either of these insurance companies:  Kaiser Permanete vs. Carefirst BCBS/PPO?  I need approval, not hassles. What has been your recent experience with these two insurances??? My current BMI is 43.

Kathleen,     Hi! I have BCBS/PPO through the SMW local #100. It is a self funded ins, which means that they are not covered by the Maryland law that requires them to pay for WLS. But I had NO issues at all. Less than 2 weeks after my papers were in, I had approval. My BMI was only 41, but I did have a few co-morbids, and a significant family history of obese related health issues. My Dad died at 52 from complications of a heart attack. He was over 380 lbs. My mom had COPD, Lupus, and pulmonary fibrosis. She just passed away 2 yrs ago at age 50.  Now, I say all of these because it matters MORE what your Employer covers, than what ins you have. Your employer decided what they will cover and what they won't. If it is an HMO, they are required by law in MD to cover it. HOWEVER< there are loop holes. One of them is it a self funded policy?  Another is- where are the companies located out of? Is your companies BCBS based in MD? You should find out first if either plan covers it- You would need to call Human resources or the equivillent. It really is all up to them as far as if it is covered. Then, if it is covered, go through the booklets to see what each company requires to get approved. Most often BCBS requires: a.) 6 month supervised diet with a physician b.) Medical need for surgery c.) Pychological evaluation d.) Nutritional evaluation It is a bit of work, but so worth it. Best wishes.

I had BC/BS PPO through the Federal govt and was very lucky.  My BMI was over 40 with no co=morbidities, and once I completed the pre-op tests and psych eval, my surgery was covered.  But it was with 10% copay - it still ran me about $1000 total out of pocket for the main surgery and then the correction after my complication.  I didn't even need the months of supervised dieting prior to surgery (although I probably have records of about 4 years combined  of WW documents). The folks at Sinai were also wonderful from the insurance perspective - I made all of my calls and paperwork and had my ducks in a row, but they were right behind me ready to help with any hurdles.

ask for and read the evidence of coverage booklets for each policy offered by your workplace.  Call the number if needed and determine whether WLS is excluded and whether there is any ammendment re-allowing the WLS at the end of the booklet.  Every employer purchases different options so you never know.