Blue Cross

Hello mmeyerssr,  thank you for the quick reply.  So what was the outcome of your experience? Where did you end up going to have the surgery done and how much out of pocket did it cost you when it was completed. Thanks, Kyle

 

My sugery hasn't happened yet. It is scheduled for Oct 5 2006. So I can't give you a total outcome yet. Medicare has approved of course since I do have a date. It is being done at Bothwel Regional Hospital in Sedalia MO by Dr. Hornbostel. My understanding is that Medicare pays for this surgery almost 100%. I'll post after my surgery to let you know just how much out of pocket I had to come up with. My wife doesn't have a date yet with champVA insurance. I will post more on that as well as things come in.

I have BlueCross BlueShield - Health Select in Texas. I just found out on Thursday that they will not cover any gastric surgery or weight loss surgery related to morbid obesity. They specifically say in their benefits book: "Not Covered: Weight reduction programs, services, supplies, surgeries, or gym memberships, even if the participant has medical conditions that might be helped by weight loss; or even if prescribed by a physician. Gastric Bypass and Vertical Banding are not covered for any condition." At this point, I really don't know where to go. The surgeon's office made it sound like there was no way of getting around it even through appeals. I don't even know how much the surgery costs. My doctor told me that I don't have choice but to have it. Now I'm thinking that I don't have a choice TO have it.

HI, I have FEPBlue TX. They do cover RNY and policy states just need detailed letter of medical necessity with at least two comorbities. The catch is they have the option to use the guidelines of BCBS TX which also covers RNY. Their guidelines are very detailed involving a 12 month MD/Nut diet, five year hx MO documented, etc. etc.  I am responding out of curiosity cause your plan must be an entirely different plan, BCBS TX Health SELECT. I wonder how they can be that different from BCBS TX guidelines? Wow, how frustrating that must be. I too could not pay for this privately, am not employed. Getting a job and keeping it is part of why I need the surgery. I too have an MD who insists I have to have it. Karen

BCBS of Illinois changed their requirements effective 9/1/2006.  They now only require the 6 month supervised diet instead of the 12 months.