Blue Cross Blue Shield: HMO

Keli P,

I am an employee of Blue Cross and Blue Shield. They are really good when it comes to approving WLS. The approval process takes about 2 weeks or less. BCBS is a real advocate of weightloss and trying to get people to maintain health lifestyles. I personally have the HMO and had it approved. The HMO plan is not based on state nor employer, it is one plan across the board unlike plans such as the PPO EPO PPN.  The only requirement is that you do a six month supervised diet with a nutritionist, PCP or like weigh watchers and Jenny Craig. Or have some sort of weighloss attempt with in the pass 2 years for at  least 6 months . That is not hard at all. You also have to have a pysch eval. BCBS covers all WLS even the sleeve, which most insurances consider that to be experimental. I can get you some more info if you need it. just send me an emaiol address and I will be happy to get that to u!!!!! Hope this help. Peace and Blessings

Moeuneek 

***Check out my page !

Hi Moeuneek,

I have an EPO Plan . I had gastric bypass about 12 years ago BCBS paid for everything and I would like to have the rose procedure done or some other revision..I am not sure what  kind of revision if any BCBS would pay for? I have gained about 45 lbs and have problems not feeling full for the past  year or so...Can you tell me what my options are? Good luck with your weight loss...If you can, please send me a PM (private msg) and I'll give you my email address. Thanks a million..


Thanks for any Help,
Poochie

Hello,

I am waiting for my approval for my surgery. I want the vertical sleeve. My surgeons assistant said everything look good but my insurance may require that I have a BMI or higher. My BMI is 47 will Blue Cross and Blue Shield cover me. After doing all of my research I have decided on the Sleeve.... I realized that you said you work for BCBS so Im hoping you have the answer for me the anticipation is killing me.....

Thanking you in advance

Tara

P.S. My surgeon is Dr. Singh

tse2300 , ok will be looking for you response

Hi I would like to know more information I have bibs of ga through my job

Like all the other posters said, it depends on the state.  I have Independence Blue Cross HMO here in Pennsylvania.  Generally, my experience was good.  There was no 6 month supervised diet requirement.  Basically, you need to have a BMI over 40 and/or 25-40 with documented co-morbidities.  Once the paperwork was in, a decision was made in less than 2 weeks.  My insurance has their medical policy bulletins on-line.  If you can find that for yours, it will outline their policy step by step.  Helpfully, our BCBS enables us to print out our exact policy.  If you have that you are golden - what you have to make sure of is that your employer doesn't have any riders excluding WLS.

Best Wishes,

Rhonda

thanks just starting to look and get approval

it sounds like it can happen but you have to stick to your guns

HI KELLI,

OK SO HERE IS THE DEAL I HAVE BC/BS ILLINOIS PPO.  I HAD TO DO THE 6 MONTH THING IN A WLS PROGRAM.  WITHIN THAT 6 MONTHS YOU NEED TO SEE "SOMEONE" FROM THE PROGRAM MD, DIETICIAN WHOEVER EVERY MONTH YOU SKIP A MONTH YOU START OVER.  ALSO YOU WILL  BE REQUIRED TO MEET CERTAIN BMI REQUIREMENTS AND HAVE A PSYCH EVAL AS WELL AS A SLEEP STUDY.  THE GOOD NEWS IS I HAD MY SURGERY ON THE 14TH OF SEPT--- I WAS APPROVED BY BCBS IN JULY AND I WAS TOLD THEN THAT AS OF AUGUST 2009 THE 6 MONTH REQUIRMENT WAS CHANGING TO A 3 MONTH REQUIREMENT.  WOO HOO FOR YOU!!!!  MY BEST ADVICE THOUGH IS TO FIND A PROGRAM  THAT YOU LIKE THAT IS A "BLUE CHOICE" HOSP/PROGRAM.  WHAT THAT MEANS IS THAT BCBS HAS GOTTEN THERE SURGICAL PLAN AND PROGRAM PLAN AND SUPPORT IT.  I SAY THAT CAUSE I HAD MINE DONE AT NORTHWESTERN WHICH IS A "BLUE CHOICE" HOSPITAL BUT I WENT TO 2 OTHER PROGRAMS BEFORE THAT AND I WAS DENIED ON BOTH (FUNNY I DID THE SAME STEPS FOR ALL 3).  THERE ARE "BLUE CHOICE" HOSPITALS IN THE SOUTH SUBURBS OF CHICAGO.  THE FIRST STEP FOR YOU THOUGH IS TO CALL BCBS OR TALK TO YOUR EMPLOYEER "PERSON" WHO HANDLES YOUR INSURANCE AND SEE IF IT IS A COVERED BENEFIT WITH YOUR PLAN.  I FOUND CALLING BCBS AND ASKING THEM DIRECTLY IF THIS WAS A COVERED PLAN AND WHAT STEPS NEEDED TO BE DONE TO HAVE IT COVERED WAS THE EASIEST ROUTE. 

GOOD LUCK ON ALL THAT HOPE IT WORKS OUT AND BTW DONT LET BCBS PUSH YA AROUND I THINK ITS ONE OF THE BEST INSURANCE COVERAGE AS WELL AS A GIANT PAIN IN THE ARSE TO GET THINGS COVERED SO DONT LET THEM GIVE YA THE RUN AROUND!