BCBS of Utah....but I'm in GA

Hello everyone. I hope someone could help me out on this issue. I have Recence BCBS through my company (located out of Salt Lake City,Utah). However, I am in a satellite office in Atlanta, GA. In our policy we have an exclusion that reads " No benefits will be provided for any of the following conditions, treatments, services, supplies, or accommodations, or for any direct complications or consequences thereof. GASTRIC PROCEDURES Services and supplies for or in connection with gastric or intestinal bypass, gastric stapling, or other similar surgical procedure, or for or in connection with reversal or revision of such procedures." My question is...since GA insurance companies have to offer WLS if medically necessary, then do I have any fighting room? I need any suggestions you might have. I was also thinking about dropping my insurance with work and getting insurance in GA? Any ideas????

Georgia's law applies only to fully insured coverage, not a self funded plan. If you want to buy a insurance policy that covers WLS in Georgia, try BCBS of Georgia. The main office is in Buckhead. I don't know for sure, but that may be a possibility for you.

I have BCBS of Georgia. It soes NOT cover the surgery. It all depends upon the policy. I heard that as of 1/1/05 BCBS was going to exclude it from all policies unless the company they are carring it for pays for the additional coverage.

Loretta, the staff at BCBSGA has assured me of this policy change *many* times. BTW, is there really a *law* in GA that mandates that WLS must be covered if medically necessary? I have been able to find documentation regarding a bill, but as far as I can tell, this bill was never passed. Thanks! K

There is no law that mandates this coverage in Georgia. At one point I contacted the insurance commissioner and state legislators. One legislator tried to get a bill pass but it never did. Many policies are BCBS but are only administrated by BCBS. That means they are self funded by the company the individual works for. An example would be like in my case. My BCBS is through the Medical College of Georgia. They offer different types of polices (Traditional, PPO, HMO). Right now the Traditional (which I have) will not cover Gastric Bypass surgery but the HMO or PPO might if its medically neccessary. Since I am on disability I also have Medicare and they will not let me switch to PPO or HMO. To make things more difficult even Medicare is managed differently in different states. I wrote and called government agencies about it also. One thing.....if yours is self funded by your employer you can always ask them to make an except and fund it themself. But better lucky than I had because MCG wouldn't. I guess they would rather see me stay on disability.

P.S. I talked to 2 Gastric Surgeons offices in Georgia. Both have posted notices of BCBS not covering in 2005.