BCBS Approval?

So I've been told that since the beginning of the year that BCBS dosent cover Gastic Bypass surgery anymore. Has anyone run into this? Personally I dont want to pay 20,000 for this and would love for them to pay it. Can I fight something that they say they wont cover and have a chance of winning? I dont know where to start, Its like I'm blind trying to find my way through a maze. Can anyone help?

It isn't necessarily a BCBS decision. If your employer chooses to offer this coverage and uses BCBS as the medical insurance administrator / vendor, the coverage is provided. I have BCBS HMO and had surgery on August 1st. Check with your employer representative for the facts about coverage.

Hi Camille I also have BCBS HMO, I had surgery 7/5. After I went to the seminar, I called BCBS and checked to see if it is covered, it took them a couple of days to go over my policy but they were able to tell me that it was covered. I went through Emory Bariatrics(very good docs) they require testing to be done(which most of it is scheduled for one day) BCBS also requires a few things for approval(diet history, weight history, letter of medical neccesity as well as medical clearance from your PCP) They approved me about 2weeks after getting all the information, they only thing that they did the was a pain was that they give you a 90 day time frame to get the surgery done after approval, the bad part was that the wrote the letter in May and I didnt get it until June. Hope this helps Erica

Hi Camille, I have BCBS State Merit HMO and my office manager called last month to see if WLS was covered. The CSR stated that BCBS has stopped covering all types of WLS . Please call BCBS and with CSR and found out if the surgery will covered. Best Wishes, Tammie G.

BCBS has stopped covering it as a normal policy; however Employers have an option to pick up the coverage if they want it as a rider to the policy. So check with BCBS and also check with your employer. I was told BCBS would stop covering WLS on 01/01/05 and I had my surgery on 02/16/05, but Employer had elected to keep the coverage lucky for me! Good luck to you! Kelly S

Camille, Freedom and Melissa R are right, sometimes it can depend on the company worked for, I called BCBS at the beginning of my journey and they said that it depends on what your company has taken out, and if they took out the bariatric coverage then yes it will cover it. My hubbys company Lowe's took the coverage out and they cover it, atleast until their renewal date on Jan, 06', so it is best to check with ur company. Best of luck, Melissa

Camille, I really feel for you ... we have BCBS of GA and as of June 30th they stopped all bariatric procedures. I am one of the ones that went through ALL KINDS of crap not due to needing gastric surgery for obesity but I had Vertical Banded Gastroplasty back in '93 (LONG before I was in GA or even knew my new husband) and due to abdominal trauma back in '01 I have since learned at the New Year my VBG has failed and I am in declining health due to it. Long story short is I do need GASTRIC surgery, which happens to be gastric bypass, to correct my failed VBG. If it makes sense it is the same procedure but a different diagnoses and coding. I am in a lifethreatening situation Literally it took not only my own GI doctor here but also a compiled group of approximently 4 surgeons, 2 different medical facilities, and 3 additional doctors all working with the Director of BCBS (who is also a surgeon) to finally get everything in place for my procedure to be approved and planned. We just received our date for Surgery Monday, I'm going in on September 12th, and it was H*ll getting it approved! We've been working on it since early April when I began to really get sick. BCBS is REAL cut and dry with not paying for it anymore, even in a situation like mine they didn't WANT to pay for it, however they are because I am what they consider a rare exception because I am a prior WLS patient. I need corrective surgery or I wont live past a year or two most. Another thing they looked at is that it is going to be more cost efficient for them to pay for it because at the rate I am getting sicker it would cost them MORE to give me any kind of quality of life. I do understand how you feel though. And I know as far as what several BCBS reps for GA have told me personally, including supervisors, that BCBS is phasing out bariatric coverage in this state, with exception as Kelly mentioned some regions MAY offer certain employers bariatric coverage, but even then it is not necessarily so. It is up to BCBS that they would even grant the coverage. I know this also because my husband's boss spoke to BCBS and told them he would do what ever necessary for them to cover me and even with that our region wasn't allowing it as an option. So by the Graces we got it through. Like I said, it is a medical/surgical, gastric procedure and not bariatric. Wish I had more upbeat info for you. Sorry .....

Lisa, I myself have called BCBS 3 times since may and everyone I talk to tells me it depends on whether the company you work for chose to take that coverage or not. In my case they said that Lowe's (hubby's employer) is covering the bariatric atleast through their renewal date of Jan. 06', so just because one plan of BCBS isn't covering anylonger doesn't mean they all aren't. I have BCBS POS and they say they are covering it atleast until the Jan. 06' renewal date. Hugs, Melissa

Hi, Camille! I have BCBS HMO Blue Choice and they covered me without any problems...I did have to go through very extensive process/testing and I did use a very reputable Doctor Procter.... but once my packet was submitted they approved almost instantly...that was less than 2 month ago.. even though my BMI was sort of marginal and I didn't have much comorbid conditions to show....Anyway..... you just have to call them and ask about YOUR Policy...I guess, everyone has a different story.... but there is no way around finding out about what applies to YOUR case.... the Best of luck to you, Rita