Just read the requirements for BCBS coverage of bariatrics for state employees

As you may know, the legislature passed a bill stating BCBS needed to start providing bariatric surgery for state employees. So, starting Sept 1, 2009 they will require the following things-
1. One year of medically supervised diet!!!
2. Five years of continuously having BCBS Health Select before surgery.
3. BMI of 40 or higher, 35 with co-morbidities
4. Coverage is employee only-no other family members
5. A significant deductible and copays to keep this coverage cost neutral to the state.

As one of my co-workers said, it might be easier to leap to Mars than to jump through these hoops.
I knew it wasn't going to be easy but I had no idea. I'm thankful I had other insurance to get mine. I just feel sad for those state employees that I know that need it.

Wow! I'm glad to see them finally doing this but of course I only meet one of the requirements. I wonder if the doctor says it is medically necessary and writes a letter to the insurance company, would they wave the other things like if you have kids on your insurance, the time you have had the insurance, etc. I got the BMI met plus several co-morbidites.

Stephanie

NOT likely that they'll make any exceptions. Its not the insurance that has the issue-Blue Cross covers surgery. Its the state that has the contract exclusion currently, and is setting all the new rules.

Why can't they realize that in the long run, the surgery is cheap compared to the cost of the health problems that can result from obesity? 

I can tell you!! The insurance companies have figured out that the average time they keep a person with their company is something like 2.5 years. Therefore it is not like the old days when they had them around long enough to see the health savings for that particular company.  It's a mess and no matter what happens, I fear it will be harder and harder to get WLS covered because I think the insurance companies are evil incarnate.  Yes this is really Yvonne....yes I really said something bad about something but my husband and I are self employed and you cannot imagine what we have to pay to just have have enough insurance to cover us in case we get hit by a truck and might live.  Otherwise we pay for it all.  Full price on all of it.....prescriptions, doc visits...much less something like a colonoscopy or mammogram...that I haven't had in way too long.  It is sad.

p.s. this is not about any of the current insurance stuff going on now.  It has been like this for us for several years.

That is the same as having NO coverage....sheesh!

So is this for teachers or what? I am a teacher and I have BCBS.  I didn't have any trouble getting approved. I had to do 6 months of diet junk, have a BMI over 40, and that was it.  I met all of the qualifications easily.  I was actually very surprised that I didn't have trouble getting insurrance approval.  I did hear that next year they are only allowing certain hospitals to perform the surgery.  I guess they are trying to get rid of what my doctor calls "doc in the boxes".

If that is the new criteria for teachers I am glad I did mine when I did.

Tonya

Nope- sorry- I meant to say employees who are covered by ERS-Employee Retirement System. Teachers have their own-TRS- that covers their insurance rules/regs.

I'm glad I had mine done when I did. I would be screwed now if I didn't.