Blue Cross Blue Shield: HMO

I am interested in WLS but I am concerned about my coverage....what are some of your experiences with this insurance?

Here is the catch it depends on state and employer mine was blue cross blue shield of NC during the first class the nurse tols us this group was the luckiest becuae she could pretty much get approval over the phone , and she did but that maybe becuase luckily the surgeon I picked was head of the baratric surgery at wake forest and they are labeled the blue cross center of execelenceso went to my visits like I was suppose to and they actually set my surgery date before even turning in paper work the the faxed of the paper work and called them same day and had approval so I was lucky but I work for a european company and they are big on getting the weight of anyway you can in
when talking to the head shrink for surgery he said that almost all stuys that have been done on gastric bypass have been done over in europe just think they are more open to this than U.S companys of course that could be that there is no big profit in turning people down for medical care there because of Goverment run coverage may take you forever there to get into doctor but when you do they will give you what you need if it make since in the long term where the insurance company here and the company try make insurance as low as possible by signing off to not cover stuff like this.

I am getting ready to be eligibile for bcbs here in south carolina through work.  My employer who also wants the surgery says that our plan does not cover the surgery.  Is there any hope in getting bcbs to cover it?  

Some of my family members want me to go to this doctor in Mexico, but I am hell bent on not resorting to that.  I would appreciate any advice you can give me.

Nope.

WLS requires an extra premium to be paid by the employer.  If he doesn't buy that rider you have no wls benefits.  No paid premium, no benefits.

Mexico is not a bad option but you can't shop by price, you have to shop by skill JUST like in the US.  The people that come home with massive problems from Mexico ... 99% of the time #1) they shopped by price, #2) they went to Tijuana.

Just do your research.

I totally agree with Bill, it depends what type of BCBS you have.  I had to do the 6mos supervised diet plan, psch eval, sleep study the whole nine for me.  The good things is that whe I started I looked up BCBS policy for wls and once I went to a seminar, they told me to do all of the above just in case.  I started making appointments and it seemed like everything was moving so fast, then I started getting tired of the appts. but I hung in there, seemed like the 6 mos was over in no time and when my paper work was submitted I got approved on the first try.  You may or may not have to do what I did, but if you do stay encouraged.  I have BCBS federal.  If you have any more questions just let me know.  I'll help as much as I can.

Call the number on the back of the card.  they will tell you everything you need to know.  They have a web site that also answers all of your Q/A

I have the MD version and all I had to pay was $20.00 specialist co-pays.  There was 4

I have BCBS of MA and breezed right through the approval process.  Of course, I give credit to my surgeon and my PCP for providing the medical necessity backup so that I met the criteria for WLS.  That has a lot to do with it. 

You can be part of that process by making sure the approval request from your WLS addresses all the points listed in the policy.  You can get a copy of that policy by calling the customer service number on your insurance card or on line at your insurance company's web site.

Fingers crossed for ya,
    Sandie

It does depend on your state and employer. With that said I do have BCBS HMO of MASS.....They paid for my lap bnad and 3 years later payed for the band removal and coversion to RNY. They also payed for all my band fills when I was getting them. NO complaints! and both time had approval within 2 weeks.

Call the number on the back of your card and ask for memeber servicese and ask them to send you the criteria information. Ask them if the RNY and the lap band are both covered. But make sure you ask them to send you the information about what needs to be met to be approved. I work in the insurance industry and lot more insurances are covering it but you need to meet specific criterias. Some insurances are easier to pass through then others. Some might want you to have 6 apts. w/your physician, 1 each month, and they must be for weight loss checks and must be on the cliams form as obesity and or weight check. Hope that helps.

I had BCBS of Tx HMO and had no problems at all. They did not cover the lap band but did cover the RNY and that is what I had. But it depends on your doctor and how aggresive they are. I went in for my appointment with my doctor and they schedule me for sleep study, psy eval, ultrasound, and blood work before leaving their office. I had all of this done within a week. They turned it in to BCBS of TX and I was approved maybe 2 weeks later. They were very fast for me.

Brenda