Help anyone have bcbs ppo in MD

Im just at the begaining of my journey but worried. All the old posts with BCBS PPO in MD with companyies with less the 50 workers don't get approved. Has anyone been aproved lately working for a small company.

I have bcbs ppo but I work for the city of baltimore and I am still going through the process of being approved...ie. doing the steps required...before being submitted for approval...sorry, I hope you find the answer you need...

Hey there and welcome to the Maryland board!

I think the issue here is not whether you're approved instead if your company's policy has it included in their coverage. From what I've read on the board before, for companies that are larger, by law they have to include it in their coverage. However for smaller companies such as yours, it is optional.

You might want to give your insurance company a call to see if it is included on your company's policy. If so, I know BCBS has their own website where you can search for Bariatric surgery and you'll find articles there that will tell you about the procedure AND whether or not it is a covered benefit as well as the steps to take to meet their requirements.

I hope this information helps!

Again, Welcome!

Thank you. Will call the BCBS. didn't know if calling them before was going to be a bad thing or even hurt my approval.  i'm know in my heart this is what I need and want to do. Just worrie that the door will close in my face. 
Thanks again,
Crissy

Crissy,

If they are like any other insurance agencies they will be happy to give you the information you need. There's not really a black mark that goes on your record if you call

this is from carefirst bcbs web site...but if your company has an exclusion for WLS they may not cover it...

Post Date: 8/5/08 2:51 pm
Look what else I found...I did find their policies...woohoo!

Medical Policy

7.01.036 Obesity and Morbid Obesity Original MPC Approval: 04/01/98 Last Review: 03/13/2008 Last Revision: 06/16/2008

Policy Guidelines Policy Guidelines

Surgical treatment of morbid obesity is considered to be a viable treatment option in patients who meet allof the following criteria:

Age:

• 18 years old or older and

Psychological examination:

• complete a psychological examination to determine readiness and fitness for surgery and necessary postoperative lifestyle changes and

Structured diet program:

• Maryland and D.C. plan members only: must complete a structured diet program in the 2-year period that immediately precedes the request for the surgery by participation in either:

- one structured diet program for 6 consecutive months or

- two structured, non-concurrent, diet programs for 3 consecutive months. (can include commonly available diet programs such as Weigh****chers® or Jenny Craig®) and

Weight requirement:

• Maryland and D.C. plan members only: must meet eitherof the following criteria:

  - BMI of 40; or

  - BMI equal to or greater than 35, in combination with one or moreof the following co-morbid conditions:

  hypertension;

  a cardiopulmonary condition;

  sleep apnea;

  diabetes mellitus; or

  any life threatening or serious medical condition that is weight induced

Thank all so much. Found the info on the BCBS web-site. also i'm calling BCBS  today, to receive other answers i need.
Once again thank you. 
Crissy

well most of them ask you for the procedure code so make sure you ask them what bariatric procedure is covered im sure its only medically nessasary ones but go for it good luck

I have Blue Cross/Blue Shield PPO in MD, but your policy might be vastly different than mine is (I have insurance under my husband's job with the Federal Government).  A small company like yours will likely have very different requirements than what I had to go through.  Contact your HR department and call BC/BS to get your plan's specific details.

Having said that, my experience was almost pain free.  Paperwork was submitted to my insurance company, and within the week I was approved.  I did not have to  do any 6-month dietary counseling, diets, or anything other than show up on the day of surgery. 

I just got my final Explanation of Benefits last week from BC/BS, and the only thing I had to pay was a $100 co-pay. 

Good luck to you.

 

It's was a very hard and long weekend. My company is under 100 people in the US, so they do not cover any of the WS. I cryed so hard, even though my heart already knew. Sunday got myself together and went to a meeting. There a lady said that she took out loans. All I thought was OK is this the way I need to go! My credit is not good at all. My wonderful mom that want to the meeting with me, turned and said “ I will co-sign for you”. Wow! I love my MOM! Here come the tears! MY JOURNEY HAS A NEW PATH!