Blue Cross

Hi! Just figured out this websit and I could ask questions all night. I have been researching WLS for a while now, I went to OHSU seminar and am working to get everything together. I was wondering if anyone out there has been thru the approval process with Blue cross and could tell me what I have to look forward to? :)

Well, fine! I'll post here, too, lol. Guess that means you found the state board. I had BC/BS of Pennsylvania (my husband works in Oregon and his company is headquartered in Oregon but it seems that they got better insurance to go through PA than Regence in Oregon). Anyway, they required a six month doctor supervised diet sometime within the past two years. It actually was easier than I thought it would be. I also sent a letter with the information my surgeon prepared (kinda like a pre-appeal letter telling them all I had done and what I needed and that I would only consider lap band). I was approved in about a month. Lori

Too funny, Yes I did find this site, last night. My Blue Cross is thru S. Carolina, that is where our headqurters are. I guess I'll just wait and see. I want it to happen tomorrow, but that is never the way things go. Although, when I went to the seminar, they said that people could expect to be in surgury in 2 - 3 months from the seminar. I was diagnosed with type 2 diabetes last year, and was sent to the nutritionist then, maybe they'll consider that as diet (wishful thinking, I know.) How long were you in the hospital and out of work? Thanks for responding, It's nice to have someone to answer questions.

It really depends on what insurance product your insurer has purchased. We have Regence BC/BS and it totally STINKS for anything related to weight. It's incredible for everything else. But forget getting anything related to surgery covered. Hence, I ended up self-paying. Probably the best bet is to call your HR representative and ask if they know whether or not WLS is an included benefit. Blessings, dina

Hey Robin, I have BC/BS Federal plan. It is ok--I ended up paying more than I'd like. I did not have to have the 6 month supervised diet--just had to lose the doctors required 10lbs. They required me to go through a center of excellence. So I went through the WLC of Legacy of Good Samaritan. The insurance did not pay for the pysch. eval., only paid half of the nurse's fees at the Legacy Weight Lose Institute, and did not pay for the initial surgeon's consult fee. Most of the other services were paid for give or take $100.00 to $400.00 dollars. I think I have spent around $2500 to $3000 so far. My surgery was on 8/11/2006. Every insurance is different. Good luck, but check into the center of excellence situation because your BC/BS may not cover surgery through OHSU.

Steph- Thanks for the info, I will check on that! So you just had your surgery in August, what surgery did you have and how are you doing?

Hi Robin, I have BCBS in Oregon. I actually like my BCBS insurance. I have an out of pocket deductible for a year of $1,000. Well with all the appointments it adds up quickly so by the time I got to surgery I was past my out of pocket. That meant anything at a preferred provider was 100% covered for me. Yeah! It took me less then 4 months to start by going to the orientation and getting my gastric bypass surgery. It would have been sooner but my surgeon had a family emergency so we had to reschedule my surgery date and the best time for the both of us was about a month after the frist one was scheduled. BCBS was very helpful and great with me. I called them a lot to ask questions and double check things and they were always really nice. From the time BCBS had my papers to approve for the surgery was about a week but that was because someone was on vacation so I just called and asked them what was going on. Less then 2 hours later I got the call back saying I was approved. I went through Good Sam's Obesity Institute and everyone there has been helpful and great. Good luck.

Beka- Thanks for the info. I have actually talked to them, they say they will pay if it is medically necessary. My primary care physician is very supportive, in addition to my weight I have Type II diabetes, high blood pressure, acid reflux, and 2 months ago my triglycerides were 650. He's got me on meds for that last time he checked me they were in the 300's but that is still too high. I'm hoping that will be enough to call it medically necessary. I have an appt with him this next week to pull together the last of what he needs to do and I'm going to have him refer me to a psyc. doctor for that review. Then I should be ready for my appt with the NP that I have scheduled on the 30th of November. What proceedure did you have done, and would you do it again?

Robin, I have BCBS of MN and had no problems with approval, however, my very good friend just had her surgery last month and had BCBS of Oregon (Regence). She had to go to a clinic in Portland Oregon (from information she provided, it's the only clinic BCBS of Oregon will pay for WLS). Dr. Patterson is her surgeon. Call BCBS and ask them about the procedures for starting the process. They are slow compared to other states, but if you are truly a candidate, they will work with you. Good luck!