Question for anyone who has BCBS of NC State Health Plan...
I have BCBS of NC/State Health Plan. I understand that if you have a BMI of 40 or greater,--BCBS will cover the gastric bypass procedure and if you're between a BMI of 35 -39 you must then have a co-morbidity in order to be covered for the procedure.
At least that's my understanding and that is what everyone is telling me. If anyone else out there is exploring this option of having this procedure and you have the same insurance as me---please send me a reply. I'd be interested in trading emails. Thanks so much!!!
-Donna
At least that's my understanding and that is what everyone is telling me. If anyone else out there is exploring this option of having this procedure and you have the same insurance as me---please send me a reply. I'd be interested in trading emails. Thanks so much!!!
-Donna
"Nothing tastes as GOOD and being HEALTHY FEELS!"
RNY (3/11) Age: 45 Height: 5'5" & NO plastic surgical procedures Starting weight: 270 Lowest weight: 132 Goal weight: 135 Current weight: 138.8
Hi Donna,
I have BCBS of NC (state employee). I have to be honest. I don't know all the specifics. I looked up the coverage last September and it said that as long as I had the procedure done at a Center of Excellence, they would cover it. So, because I live in Durham, I went to the Center of Excellence run by Duke. My insurance has covered everything (except the group sessions). I have a $60 co-pay every time I go for a follow up and my in-hospital deductible was $2,500, so I am currently paying on that. Other than that, they paid.
It's been an incredibly easy experience where insurance is concerned.
Let me know if you have any other questions.
Good luck to you,
Fran
I have BCBS of NC (state employee). I have to be honest. I don't know all the specifics. I looked up the coverage last September and it said that as long as I had the procedure done at a Center of Excellence, they would cover it. So, because I live in Durham, I went to the Center of Excellence run by Duke. My insurance has covered everything (except the group sessions). I have a $60 co-pay every time I go for a follow up and my in-hospital deductible was $2,500, so I am currently paying on that. Other than that, they paid.
It's been an incredibly easy experience where insurance is concerned.
Let me know if you have any other questions.
Good luck to you,
Fran
sunshine8
on 8/13/10 3:47 am
on 8/13/10 3:47 am
Donna-I have the same understanding as you.
In addition the surgery has to be done at a Center of Distinction which is different from Center of Excellence....................My understanding of this is COD is something created by BCBS and COE is something that was created by the physicians and others in medical community. I have learned today that in addition to Duke/Durham Regional have COD , now Rex Hospital has it.
Wahoooooooooo!! Been waiting to hear that! Might be a bit before we see it posted on the BCBS Website.
Take Care,
~Sunshine
In addition the surgery has to be done at a Center of Distinction which is different from Center of Excellence....................My understanding of this is COD is something created by BCBS and COE is something that was created by the physicians and others in medical community. I have learned today that in addition to Duke/Durham Regional have COD , now Rex Hospital has it.
Wahoooooooooo!! Been waiting to hear that! Might be a bit before we see it posted on the BCBS Website.
Take Care,
~Sunshine
Thank you SO MUCH for this info. I have been Googling for a week trying to find out if my NC Blue Cross required me to pay all costs not covered before surgery. My Surgeon Consult is July 1st. I am thrilled to learn from you that I can make payments on the 30% that the insurance doesn't pay (I have 70/30 policy).
I have talked to BCBS and they say I have to pay a deductible of $933, a hospital copay of $291, have 4 covered Nutritional visits, and $81 copay for each dr. visit.
I am so excited for my Consult on July 1st.
Thanks again!
ToBeAble
on 8/13/10 11:32 am
on 8/13/10 11:32 am
Hi Donna,
I have BCBS of NC insurance, although not a state employee's plan. (Mine is through my own small business plan.) I just had RNY two weeks ago at Duke, and BCBS DID cover my surgery. I think you have the parameters correct, although if you log into the bcbsnc.com website under your account and search for bariatric surgery, you'll be able to see/print out their policy.
BTW, so far, my experience with Duke Metabolic and Weight Loss Surgery Center has been wonderful. (Six more days until I'm off protein shakes and start trying foods!!)
Good luck with your journey!
Laura
I have BCBS of NC insurance, although not a state employee's plan. (Mine is through my own small business plan.) I just had RNY two weeks ago at Duke, and BCBS DID cover my surgery. I think you have the parameters correct, although if you log into the bcbsnc.com website under your account and search for bariatric surgery, you'll be able to see/print out their policy.
BTW, so far, my experience with Duke Metabolic and Weight Loss Surgery Center has been wonderful. (Six more days until I'm off protein shakes and start trying foods!!)
Good luck with your journey!
Laura
I wish I could be more helpful but I can tell you that I have BCBS of NC and my surgery was covered, with a slight co-pay. My suggestion is to call BCBSofNC directly and ask them what you need to do to qualify for the surgery. I was at a 55% BMI, so my surgery was approved the first time.
I know, for a fact, they will not cover the sleeve. I had looked into lap band but unltimately went with the Rouen-y surgery. I came home from the hopsital Thursday.
Good luck to you and pull that insurance card out and call BCBSofNC directly. That is what they get paid for!
I know, for a fact, they will not cover the sleeve. I had looked into lap band but unltimately went with the Rouen-y surgery. I came home from the hopsital Thursday.
Good luck to you and pull that insurance card out and call BCBSofNC directly. That is what they get paid for!
Blessings,
Pam Solly
Pam Solly
I have BCBS of NC / State Health Plan as well. Below you will find the link to their policies for bariatric surgery coverage for weight loss:
https://www.bcbsnc.com/assets/services/public/pdfs/medicalpo licy/surgery_for_morbid_obesity.pdf
It outlines the criteria for approval beginning on page 4 of the document under the sub-topic heading of "When Surgery for Morbid Obesity is covered".
I don't know if it mentions it in that particular document, but your BMI must be LESS than 55 or they will not give prior approval as surgery at that particular BMI becomes extremely risky.
https://www.bcbsnc.com/assets/services/public/pdfs/medicalpo licy/surgery_for_morbid_obesity.pdf
It outlines the criteria for approval beginning on page 4 of the document under the sub-topic heading of "When Surgery for Morbid Obesity is covered".
I don't know if it mentions it in that particular document, but your BMI must be LESS than 55 or they will not give prior approval as surgery at that particular BMI becomes extremely risky.
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